Brachytherapy for prostate cancer
Radiotherapy for prostate cancer is sometimes given from inside the body. This is called internal radiotherapy or brachytherapy.
Brachytherapy (internal radiotherapy) gives high doses of radiation directly to the prostate. Areas close by, such as the rectum and the bladder, get a much lower dose.
Brachytherapy can be given:
- on its own to treat low-risk prostate cancer or with hormonal therapy
- before or after external beam radiotherapy for early prostate cancer or locally advanced prostate cancer. This is sometimes called a boost.
With early prostate cancer, you usually have boost brachytherapy if the cancer is intermediate-risk and high-risk. If you have locally advanced prostate cancer you will have brachytherapy with external radiotherapy.
There are 2 ways brachytherapy is given:
- Radioactive seed implants or low-dose rate (LDR) brachytherapy
Small radioactive seeds are placed in the prostate. This is the most common type of brachytherapy for early prostate cancer. You have this treatment done in a day.
- High-dose rate (HDR) brachytherapy
Thin tubes are placed in the prostate attached to a machine that sends a radioactive source into the tubes. You may have this with external radiotherapy to treat early or locally advanced prostate cancer.
You usually have antibiotics before brachytherapy and for a few days after to help prevent infection. You may also be given tablets to help you pass urine (pee) more easily after treatment. Brachytherapy may not be suitable if you have a lot of urinary symptoms.
There may be some differences in how each hospital gives brachytherapy. Your doctor or nurse will explain what will happen.
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.
Planning your treatment
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.
Implanting the seeds
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.
After radioactive seed brachytherapy
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.
The radioactivity from the seeds is absorbed from inside the prostate, so it is safe for you to be around other people. As a precaution, you should avoid periods of close contact with children and anyone pregnant for the first few months. It is safe for them to be in the same room as you. But you will be asked to keep a certain distance from them. Avoid holding or hugging anyone who is pregnant or children for more than a few minutes each day.
Your doctor or nurse will give you specific advice about the safety precautions you need to follow.
Your doctor will advise you to use a condom during sex for the first 2 months after the seeds have been put in. There is a slight risk of passing a seed in your semen when you ejaculate. Place used condoms in a plastic bag and dispose of them in a bin bag.
If you receive anal sex, doctors usually advise avoiding this for several months. This is to protect your partner until most of the radiation has worn off. If you are worried, talk to your doctor or nurse.
Your semen may be coloured black or brown for a short time. This is caused by some bleeding during the procedure. It is harmless. You will still need to use contraception to avoid a pregnancy.
Thin tubes are placed in the prostate. They are attached to a machine that sends a radioactive source into the tubes for a set time. The source and tubes are then removed.
You will have a general or a spinal anaesthetic (injection of painkillers into your spine) to have HDR brachytherapy. If you have a spinal anaesthetic, you will be awake but will not feel any pain. You may need to stay in hospital overnight.
- For early prostate cancer - if you are having HDR brachytherapy on its own, you will usually have 2 treatments. If you are having HDR as a boost after external radiotherapy, you only need 1 treatment.
- For locally advanced prostate cancer - you usually have HDR brachytherapy 1 to 2 weeks before you start external radiotherapy or when you finish external radiotherapy.
Having the tubes put in
Your doctor passes an ultrasound probe into the back passage (rectum) to take pictures of the prostate. This helps them to plan the number of tubes needed and where they should be placed. They sometimes also use a CT scan to help position the tubes.
Your doctor passes the tubes that deliver the brachytherapy into your prostate. This is done through the skin between the scrotum and back passage. They may also put a tube into the bladder to drain urine (catheter). This prevents any swelling of the prostate stopping you passing urine. They remove the catheter before you go home.
Having HDR brachytherapy
The nurses take you to a treatment room that has the HDR machine. They attach the tubes to the machine. The machine sends the radioactive source into the tubes going into the prostate. A computer monitors how long the radioactive source stays in place. The treatment takes about an hour.
The tubes can be uncomfortable, and you must stay lying down while they are in place. After HDR brachytherapy is finished, the radioactive material is returned to the machine and the tubes are removed.
After HDR brachytherapy
After treatment, you have no radioactive material inside you, so there is no risk in being around other people.
Your doctor or nurse will explain what to expect after treatment. Before you go home, they will give you antibiotics and tablets to help you to pass urine more easily. Take them exactly as explained.
You need to avoid doing heavy lifting or energetic physical activity for 2 to 3 days. The area between your legs can feel bruised and inflamed for a few days. Your doctor can prescribe painkillers to take.
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.
Effects on the bladder
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.
Not being able to pass urine
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.
If you have a low-risk cancer, you may be asked to decide between external beam radiotherapy and brachytherapy. This is because your doctor thinks they are both effective treatments for you. It is important to talk about the possible advantages and disadvantages of each treatment with your doctor or nurse. You can then decide with them which treatment is right for you.
Benefits of brachytherapy
- You usually only need 1 or 2 visits to hospital, rather than weeks of external beam radiotherapy treatment.
- There may be a lower risk of some side effects because there is less damage to the surrounding healthy tissue.
- You can usually get back to your day-to-day activities within a few days.
Disadvantages of brachytherapy
- You need a general or a spinal anaesthetic.
- With radioactive seeds (not with HDR brachytherapy) you need to avoid close contact with children or anyone who is pregnant for a few months after treatment.
- Short term urinary side effects may be more severe than with external beam radiotherapy.
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at email@example.com
C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from www.esmo.org/guidelines/genitourinary-cancers/prostate-cancer
National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131) Available at www.nice.org.uk/guidance/ng131
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