Prostate brachytherapy (brak-e-THER-uh-pee) is a form of radiation therapy used to treat prostate cancer. Prostate brachytherapy involves placing devices containing radiation in the prostate gland close to the cancer cells.

Prostate brachytherapy procedures vary based on the type of radiation you'll receive. Temporary prostate brachytherapy involves placing radioactive wires in the prostate gland for several minutes before the wires are removed. Permanent prostate brachytherapy involves placing radioactive seeds in the prostate gland permanently, where they slowly release radiation.

The goal of prostate brachytherapy is to place the radiation close to the cancer cells, where the radiation can kill the cancer cells while causing less damage to healthy tissue nearby. Prostate brachytherapy side effects can include difficulty urinating and erectile dysfunction.

Prostate brachytherapy is a type of radiation therapy used to treat prostate cancer. If you have early-stage prostate cancer, brachytherapy may be the only treatment used. For larger prostate cancers, brachytherapy may be used along with other treatments, such as external beam radiation or hormone therapy.

Prostate brachytherapy is generally not used for advanced prostate cancer that has spread to the lymph nodes or to distant areas of the body.

Prostate brachytherapy may cause side effects, including:

  • Difficulty starting urination
  • Frequently feeling an urgent need to urinate
  • Feeling a burning sensation when urinating
  • Blood in urine
  • Needing to urinate at night
  • Not being able to empty your bladder completely
  • Narrowing of the tube that carries urine from your bladder to the outside of your body (urethra)
  • Erectile dysfunction
  • Bleeding from the rectum
  • Blood in stool
  • Diarrhea

Doctors may often use medications to reduce side effects of treatment. Side effects of prostate brachytherapy may become less noticeable over time.

To prepare for prostate brachytherapy, you will:

  • Meet with a radiation oncologist. A radiation oncologist is a doctor who uses radiation to treat cancer. The radiation oncologist will explain the available procedures and the possible risks and benefits of each. Together you can decide whether prostate brachytherapy is the best treatment for you.
  • Undergo scans to plan for treatment. Before you begin treatment, you'll undergo imaging scans of your prostate, such as ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI). These scans help your radiation oncologist and other members of the treatment planning team decide the dose and positioning of the radiation.

During prostate brachytherapy

What you can expect during prostate brachytherapy depends on the type of brachytherapy treatment you'll receive.

  • Permanent prostate brachytherapy. Prostate brachytherapy that stays in your body permanently is called low-dose-rate brachytherapy or seed implants. During this procedure, you may be placed under anesthesia so that you aren't aware during the procedure and won't feel pain. A wand-like instrument is inserted in your rectum. This instrument creates ultrasound pictures of your prostate. The pictures help guide a long needle that's used to place many seed-like radioactive implants in your prostate. The needle is inserted through the skin between your scrotum and your anus (perineum) and into your prostate. The seeds, about the size of grains of rice, will give off radiation for a few months and will remain in your body permanently.

    Once the seeds are placed in your body, you'll spend some time in a recovery area, and then you can go home. The low levels of radiation in the seeds generally aren't harmful to others, but as a precaution, you may be asked to avoid close contact with children and pregnant women for a short time. Your doctor may advise you to wear a condom during sex.

  • Temporary prostate brachytherapy. Prostate brachytherapy using radiation that stays in your body for several minutes at a time is called high-dose-rate (HDR) brachytherapy. During HDR brachytherapy, you'll be under anesthesia so that you aren't aware and won't feel pain. Thin tubes are inserted through the perineum and into your prostate at precise locations. The tubes are connected to a machine that feeds wires containing radiation into the prostate. The radioactive wires are left in place for a set amount of time, typically several minutes. Then the radioactive wires are removed. The tubes are left in place, and you may spend the night in the hospital and repeat the procedure the next day. Most men undergo a few treatments. Once your treatments are complete, the tubes are removed.

After the procedure

After prostate brachytherapy, you can expect some pain and swelling in the perineum where the radiation needles were inserted. You may find relief by placing an ice pack over the area or taking acetaminophen (Tylenol, others). Tell your doctor if these measures aren't controlling your pain.

You can resume normal activities when you feel up to it. Avoid strenuous activity, such as running, or activities that may irritate the perineum, such as riding a bike, until the area where the radiation was inserted is no longer tender.

After prostate brachytherapy, you may undergo follow-up blood tests to measure the level of prostate-specific antigen (PSA) in your blood. These tests may give your doctor an idea of whether treatment has been successful. Ask your doctor when you can expect to know whether your prostate cancer is responding to treatment.

Feb. 26, 2014