Brachytherapy for prostate cancer

Brachytherapy is sometimes called internal radiotherapy, implant therapy or seed implantation.

There are two ways of giving brachytherapy for prostate cancer:

  • Permanent seed brachytherapy (also called low-dose rate) involves having small radioactive seeds placed inside the prostate gland. This is the most common way of giving brachytherapy.
  • High-dose rate brachytherapy involves having thin tubes temporarily placed into the prostate gland. Radioactive material is passed through the tubes into the prostate during treatment.

Before permanent seed brachytherapy you will have a scan of the prostate gland. This will help the doctors decide how many seeds are needed and where they should be placed. You ‘ll have the seeds put in under a general anaesthetic. Most men can go home on the same day.

High-dose rate brachytherapy is usually given under a general anaesthetic. You may need to stay in hospital overnight. The seeds are in the prostate gland just for the time of your treatment. The tubes are removed once your treatment is over.

Your doctor can talk to you about the advantages and disadvantages of brachytherapy.

What is brachytherapy?

This type of radiotherapy is also called internal radiotherapy, implant therapy or seed implantation.

Men who have early prostate cancer may have brachytherapy on its own or with external beam radiotherapy and/or hormonal therapy. Brachytherapy is only carried out in specialist hospitals in the UK.

Brachytherapy may not be suitable for men with very large prostates. However, some men can be given hormonal therapy to reduce the size of their prostate before brachytherapy is given.

There are two ways of giving brachytherapy:

Permanent seed brachytherapy

This is sometimes known as low-dose rate (LDR) brachytherapy. This uses small, radioactive metal ‘seeds’ that are inserted into the tumour so that radiation is released slowly. The seeds are not removed but the radiation gradually fades away over about six months. There is no risk of it affecting other people.

High-dose rate (HDR) brachytherapy

This involves placing thin plastic or metal tubes into the prostate gland. A radioactive material is then inserted into the tubes by a machine. The radioactive material is left in the tubes for a set period of time and then withdrawn. After the treatment, the tubes are removed and no radioactive material is left in the prostate gland.


Planning permanent seed brachytherapy

Permanent seed brachytherapy is the most common type of brachytherapy.

Before the seeds are put into the prostate gland, the doctors will do a scan of your prostate gland to confirm its exact size and position.

You may be asked to follow a special diet for 24 hours before the scan and you may be given an enema. This is to make sure your bowel is empty so that the ultrasound picture is as clear as possible.

The scan is usually carried out in the operating theatre and may be done under a local (spinal or epidural) anaesthetic or sometimes a general anaesthetic. Your doctor passes an ultrasound probe into your rectum to take pictures of your prostate. The doctors use the pictures to decide how many radioactive seeds are needed for treatment and exactly where they should be placed.


Implanting the radioactive seeds

The procedure to put the radioactive seeds into your prostate gland may be carried out on the same day as your planning or a few weeks later.

The seeds are put in while you are under a general anaesthetic. An ultrasound probe is inserted into the rectum to show the prostate. The doctor then uses special needles to insert the radioactive seeds, through the skin between your testicles and back passage (anus), into your prostate gland. The needles are used to guide the seeds to your prostate gland. Once the seeds are in place, the doctor removes the needles and the ultrasound probe. The whole procedure usually takes about an hour.

You’ll be given antibiotics after the procedure to prevent infection. Most men go home on the same day, as soon as they’ve recovered from the anaesthetic and are able to pass urine normally. You will not be able to drive yourself home because of the anaesthetic so make sure someone else can do this. Occasionally, you may have to stay overnight.

You should avoid heavy lifting or strenuous physical activity for 2–3 days after the procedure.

All of the radioactivity from the seeds is absorbed within the prostate, so it’s completely safe for you to be around other people. But as a precaution, you should avoid long periods of close contact with women who are or could be pregnant, and children, particularly for the first few months.

It’s safe for children to be in the same room as you. You can hold or cuddle them for a few minutes each day, but don’t let them sit on your lap for long periods, for example while watching a film. Your specialist will tell you about the precautions you should take.

Although the seeds stay permanently in the prostate gland, there is a tiny chance of a single seed being passed in the semen during sex. So it’s advisable to use a condom for the first few weeks after the seeds have been put in. During this time, the semen may be coloured black or brown. This is normal and is due to bleeding that may have occurred during the procedure. Double-wrap used condoms and dispose of them in a dustbin.

I was diagnosed 10 years ago and was one of the first to be treated with brachytherapy. After having radioactive seeds, the side effects of treatment tailed off.

Harry


High dose-rate (HDR) brachytherapy

HDR brachytherapy is carried out in the operating theatre. You will usually have a general anaesthetic but some men have a local (spinal or epidural) anaesthetic. You may need to stay in overnight to have this treatment.

The specialist inserts thin metal or plastic tubes, through the skin between your testicles and back passage, into your prostate gland.

Before the tubes are put in, your doctors will do a scan to find out its exact size and position. The scan is carried out in the operating theatre. Your doctor passes an ultrasound probe into your rectum to take pictures of your prostate. The doctors use the pictures to decide the number of tubes that are needed for your treatment and exactly where they should be placed.

Once the scan is done, your specialist will put the tubes that are used to give you the brachytherapy into your prostate gland. A CT or MRI scan is taken so your specialist can work out how much radiation to give you.

After the dose has been worked out, a machine is used to insert the radioactive material into the tubes. A computer monitors how long the radioactive material stays in place for, which is usually minutes. This may be done while you are asleep with a general anaesthetic or awake.

Treatments vary. Some men need two or three treatments over a 24 hour period. If you need more than one treatment, the tubes are left in place between treatments. You will need to stay in bed while the tubes remain in place. The tubes can be uncomfortable but you will be given painkillers if you need them. Once all the treatment has been completed the tubes are removed.

A catheter is sometimes inserted into the bladder to drain urine during the treatment(s). This is because the procedure may cause some swelling of the prostate, which can lead to blockage of the urethra (the tube that drains urine from the bladder). The catheter will be removed before you go home.

At the end of each treatment session the radioactive material is returned to the machine. Once all the treatment has been completed the tubes are removed.

After the treatment you have no radioactive material inside you so it is perfectly safe for you to be with other people, including children.

HDR brachytherapy is usually given with a course of external radiotherapy but it may be given on its own.


Advantages and disadvantages

Advantages

  • It may cure prostate cancer.
  • Permanent seed brachytherapy usually only involves one session to plan and implant the seeds rather than a course of treatment, which is needed with external beam radiotherapy.
  • Side effects, such as diarrhoea, are less common with brachytherapy compared to external beam radiotherapy.

Disadvantages

  • Bladder-related side effects may be more severe with brachytherapy compared to external beam radiotherapy. These symptoms usually improve over 3–12 months.
  • A general anaesthetic is needed for the procedure and this has risks. 
  • After brachytherapy you probably won’t be able to have surgery. This is because the scar tissue from radiotherapy makes surgery too difficult.
  • As the prostate gland is left in place, there is a possibility that another prostate cancer could develop years later.

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