Brachytherapy

Brachytherapy is a way of giving radiotherapy treatment. It is sometimes called internal radiotherapy, implant therapy or seed implantation. The type of brachytherapy used to treat locally advanced prostate cancer is high-dose rate (HDR) brachytherapy. You’ll usually have a course of external beam radiotherapy as well as brachytherapy.

HDR brachytherapy involves having plastic tubes temporarily placed into the prostate gland. Radioactive material is passed into the tubes during treatment. The treatment usually lasts for some minutes. Some men need only one treatment while others need two or three treatments. You usually have a general anaesthetic for this treatment.

You may have mild soreness, bruising or discoloration in the treatment area. Other possible side effects include erection difficulties and infertility. There may also be effects on your bladder such as blood in your urine. Any side effects are likely to be worse in the first few weeks but they then start to improve.

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

Brachytherapy

Brachytherapy is also called internal radiotherapy, implant therapy or seed implantation. The type of brachytherapy that may be used to treat locally advanced prostate cancer is known as high-dose rate (HDR) brachytherapy. It’s usually given with a course of external-beam radiotherapy.

HDR brachytherapy involves placing thin, metal or plastic tubes into the prostate gland. A radioactive material is left in the tubes for a set period of time, and then withdrawn.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.


Treatment

A machine is used to insert the radioactive material into the tubes. A computer monitors the length of time the radioactive material stays in place for, which is usually minutes. This may be done while you are asleep with a general anaesthetic or while you are 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. At the end of each treatment session the radioactive material is returned to the machine. 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.

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


Side effects of brachytherapy

Brachytherapy causes similar side effects to external radiotherapy.

It’s common to feel mild soreness, and to have some bruising and discoloration between the legs for a few days after the procedure. Your doctor can prescribe painkillers to relieve this.

Erection problems

Brachytherapy can cause erection problems some years after the treatment. The risk is the same as with external radiotherapy. But your risk may be higher if you’re having external beam radiotherapy or hormonal therapy as well as brachytherapy. Ask your specialist if they are able to give you an idea of your likely risk of erection problems.

Fertility

Brachytherapy may cause infertility in some men. Your specialist will talk to you about this before your treatment.

Effects on the bowel

Brachytherapy may be less likely to affect the bowel than external radiotherapy. But if it is given with external radiotherapy, the side effects will be the same.

Effects on the bladder

  • Blood in your urine
    You may notice some blood in your urine and semen for a few weeks. This is normal, but if it becomes severe or you have large clots, let your doctor know immediately. Drink plenty of water to help prevent blood clots and to flush the bladder.
  • Difficulty passing urine 
    The procedure may cause some men to have difficulty passing urine due to swelling. You may have a catheter put in either during or after the procedure to help manage this. It will be removed when the tissues have healed. Sometimes difficulties passing urine may develop due to narrowing of the urethra. This can happen weeks or months after the procedure.
  • Urine leakage
    This may affect a small number of men. We have more information about managing incontinence.
  • Other problems
    Some men find they have pain or discomfort when they pass urine, that they need to pass urine more often, or they have a weaker urine stream. Drink plenty of fluids and avoid caffeine to help reduce these effects.

These problems are likely to be worse in the first few weeks after treatment. Usually they will then gradually improve.

Most men will be able to return to their normal activities 1–2 weeks after treatment. But your recovery will take longer if you have external beam radiotherapy as well.


Advantages and disadvantages

Advantages

  • Brachytherapy combined with external-beam radiotherapy may lead to a cure for some men with locally advanced prostate cancer. For others it can control the cancer for many years.

Disadvantages

  • It’s usually given in combination with external-beam radiotherapy, so it may not be possible to avoid frequent visits to hospital for treatment.
  • It may cause erection problems, difficulty passing urine, urine incontinence and infertility.
  • A general anaesthetic is required for the procedure, which has risks.