Brachytherapy for prostate cancer

Small, radioactive metal ‘seeds’ are placed in the prostate and stay there permanently. They slowly release radiation until it has been used up. After a year, about 95% of the radiation will have gone.

You will have a general or a spinal anaesthetic (injection of painkillers into the spine). If you have a spinal anaesthetic, you will be awake but will not feel any pain.

Before the seeds are implanted, your doctor passes an ultrasound probe into the back passage (rectum) to take pictures of the prostate. This helps them plan how many radioactive seeds are needed and where they should be placed.

To prepare, you may need to have a special diet for 24 hours. You may also have a small amount of liquid passed into your rectum (enema). This makes sure your bowel is empty, so the ultrasound picture is clear.

The doctor passes the ultrasound probe into the rectum to show your prostate and help guide them to where to place the seeds. They pass a special needle through the skin between the scrotum and back passage (perineum) to insert the seeds into the correct position in the prostate.

Sometimes they put a tube (catheter) into your bladder to drain urine during the procedure. They insert water into the catheter to help show up the area around the bladder. You have it removed before you go home.

You can usually go home on the same day, but someone will need to take you. You will not be able to drive, because of the anaesthetic. Your doctor or nurse will explain what to expect after treatment and the precautions you need to take.

Before you go home, they give you antibiotics and tablets to help you to pass urine more easily. Take them exactly as explained.

They also give you a card to carry with you at all times. It explains the treatment you have had and gives your hospital contact details.

Brachytherapy causes similar side effects to external beam radiotherapy. If you have brachytherapy on its own, some side effects may be less severe. If you have it with external beam radiotherapy, they may be more severe.

Brachytherapy causes similar side effects to external beam radiotherapy. Having brachytherapy with external beam radiotherapy may make some side effects more severe. Some side effects may take several weeks to develop and may last for longer.

Brachytherapy for prostate cancer can cause problems getting and keeping an erection. This is called erectile dysfunction (ED).

You may have ED immediately after treatment due to swelling and bleeding. But this can improve as these problems settle down. Sometime ED develops gradually over months or years. Ask your cancer doctor about your risk of ED. If you develop ED, there are different treatments that can help.

Brachytherapy may also change ejaculations. You may find you ejaculate little or no semen.

Having brachytherapy on its own can still cause infertility, but the risk may be lower than with external beam radiotherapy. If you find this difficult to cope with or are worried about your fertility, talk to your cancer doctor. You may be able to store sperm before treatment starts.

We have more information on fertility.

Brachytherapy may cause some bowel problems for a few weeks after treatment. These are similar to the side effects caused by external radiotherapy. Sometimes they last for months.

Brachytherapy on its own is less likely than external beam radiotherapy to affect the bowel and cause late bowel effects. If bowel problems do not improve or develop later on (late effects), contact your doctor straight away. Always tell them if you pass blood from the back passage.

If you already have difficulties passing urine, you will not usually have brachytherapy, as it may make bladder problems worse.

You may see some blood in your urine and semen for a few weeks after treatment. If bleeding gets worse or you have large clots, tell your doctor straightaway. Drinking plenty of water helps flush your bladder and prevent blood clots.

You may also:

• have discomfort or pain passing urine
• need to pass urine urgently and more often.

Drinking plenty of water and avoiding caffeine and alcohol will help improve your symptoms.

With HDR brachytherapy, these symptoms should improve after a few weeks. With radioactive seed brachytherapy, they will improve over the following months as the seeds lose their radioactivity.

Brachytherapy may cause swelling of the prostate. This may make it difficult to pass urine. If this happens, you may need to have a catheter put in your bladder until the swelling goes down. This usually takes 2 to 4 weeks.

Sometimes a catheter needs to be in for a longer time until you can have surgery to remove part of the prostate (TURP).

Sometimes radiotherapy can narrow the urethra. This is called a stricture. This causes difficulties with passing urine. This may happen weeks, months or even years after treatment finishes. A stricture can be treated by passing a thin, plastic tube through the urethra to widen (dilate) it.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.