Prostate brachytherapy

Prostate brachytherapy is a treatment for prostate cancer in which radioactive seeds are placed into the prostate gland to kill cancer cells.

This page discusses permanent brachytherapy (also known as low dose-rate brachytherapy), which is the most common brachytherapy approach used in New Zealand.

As these names imply, the radioactive seeds remain inside the man’s prostate permanently, initially delivering a targeted low radiation dose and then gradually losing their radioactivity over about six months.

Why brachytherapy?

ProstateBrachytherapy is best suited to men whose prostate cancer has not spread outside the prostate and that is considered low risk.

If there is a risk of the cancer spreading then external beam radiotherapy may be used in conjunction with brachytherapy. If the cancer has obviously spread beyond the prostate gland then brachytherapy is not appropriate and other treatment options need to be investigated. 

The implanted seeds deliver about twice the dose of radiation to the prostate gland that external beam radiotherapy does. The radioactive seeds are small — less than the size of a grain of rice — and are implanted directly into the prostate gland.

Because the radiation is concentrated in a localised area, damage to healthy adjacent tissue is minimised and side effects are potentially less than those of the external beam radiotherapy procedure. A possible exception is the urethra, which is partially surrounded by the prostate and can receive high doses of radiation leading to complications such as difficulty urinating.

Brachytherapy has a distinct advantage over external beam radiotherapy in that only a short visit to a hospital is required, rather than several visits to a radiotherapy clinic. However, brachytherapy is not appropriate for many men because of their type of cancer, the size of their prostate, or because they have had prior surgical treatments such as transurethral resection of the prostate (TURP), a common surgical treatment for enlarged prostate.

The procedure

Brachytherapy is planned and performed by a radiation oncologist (a doctor who is an expert in radiation therapy for cancer) and a urologist (a doctor who is an expert in urinary system disorders).

Before the procedure it is necessary to assess the size and shape of the prostate gland, which is usually done using ultrasound scans. This enables the implant procedure to be accurately planned and for the number of seeds required to be determined. More than 100 seeds may be used in some instances.

Blood tests to measure the PSA (prostate specific antigen) and an ECG (a tracing of the heart’s electrical activity) will also be required. Bowel preparation, including a clear liquid diet and the administration of enemas, will be necessary on the day prior to the procedure to ensure that the lower bowel is clear.

The procedure itself is performed in an operating theatre using a spinal or general anaesthetic. An ultrasound probe is inserted into the rectum in order to locate the prostate gland and enable it to be seen on a monitor.

The seeds are placed into the prostate gland using needles inserted through the perineum (the area of skin between the scrotum and the anus).

Most people are able to be discharged from hospital within 24 hours of the procedure and a return to normal activity can usually be achieved within two to three days.

In order to check the position of the seeds a CT scan will be conducted about one month after the seeds have been implanted. Follow-up examinations are usually recommended every three months for the first year, then every six months after that. Rectal examinations and blood tests to measure the PSA levels are usually conducted in order to monitor the effectiveness of the implanted seeds in treating the prostate cancer.

Side effects and complications

Common side effects of prostate brachytherapy include:

• Blood in the urine: This is normal and should resolve within a few days

• Bruising and tenderness of the perineum

• A burning sensation when urinating: Drinking plenty of fluids will help to minimise this and will help prevent urinary infection

• Difficulty passing urine, or an urge to pass urine quickly or more often

• A temporary increase in the frequency of bowel motions

• Pain or burning with ejaculation

• Discolouration of the semen

• Fatigue: this is common to all types of radiation treatment.

These side effects are at their most troublesome four to six weeks after the procedure. However, for most patients they will subside completely over a period of a few months. More serious side effects can occur, including:

• Urinary incontinence (10–35% in the first few months, but few patients have leakage after one year)

• Rectal bleeding (usually just a few spots of blood)

• Ulceration of the rectum

• Erectile dysfunction (approximately 30–40% of men will have erection problems)

• Prostate brachytherapy may result in infertility.

The risks and side effects of brachytherapy should be discussed with the specialist(s) prior to treatment and should be considered when deciding whether or not to opt for this treatment. More detailed information about the treatment and radiation safety guidelines will be given by the specialist(s) performing the procedure.

Support and information

For further information and support about prostate cancer and treatment options please contact:

Cancer Society

Freephone helpline: 0800 CANCER or 0800 226 237

Email: [email protected]

Website: www.cancernz.org.nz

Prostate Cancer Foundation NZ

Freephone helpline: 0800 4 PROSTATE or 0800 477 678

Email: [email protected]

Website: www.prostate.org.nz

References

Cancer Council (2019). Understanding radiation therapy (PDF Booklet). Sydney, NSW: Cancer Council Australia. https://www.cancercouncil.com.au/wp-content/uploads/2014/05/Understanding-Radiation-Therapy-2019.pdf
Cheuck, L. (2017). Brachytherapy (radioactive seed implantation therapy) in prostate cancer (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/453349-overview [Accessed: 16/04/20]
Faculty of Radiation Oncology (2017). Brachytherapy for prostate cancer (Web Page). Sydney, NSW: Royal Australian and New Zealand College of Radiologists. https://www.targetingcancer.com.au/radiation-therapy/brachytherapy/brachytherapy-for-prostate-cancer/ [Accessed: 16/04/20]
O’Toole M.T. (Ed.) (2017). Brachytherapy. Mosby’s Dictionary of Medicine, Nursing & Health Professionals (10th ed.) St. Louis, MI: Elsevier.

Last Reviewed - April 2020

 

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