What is Prostate Brachytherapy? Purpose, Procedure & Results

Prostate brachytherapy is a targeted radiation treatment where tiny radioactive seeds are placed directly into your prostate gland. This approach allows doctors to deliver high doses of radiation precisely to cancer cells while protecting nearby healthy tissue. Think of it as placing the treatment exactly where it needs to be, rather than sending radiation through your entire body.

What is prostate brachytherapy?

Prostate brachytherapy involves implanting small radioactive seeds, each about the size of a grain of rice, directly into your prostate tissue. These seeds emit radiation over time to destroy cancer cells from the inside out. The word "brachytherapy" comes from the Greek word "brachy," meaning short distance, because the radiation travels only a very short distance.

There are two main types of prostate brachytherapy. Low-dose rate brachytherapy uses permanent seeds that stay in your prostate forever, gradually losing their radioactivity over months. High-dose rate brachytherapy uses temporary catheters that deliver stronger radiation for a few minutes, then are removed completely.

The permanent seeds become inactive over time and pose no long-term radiation risk to you or others. Your body naturally encases them in scar tissue, where they remain harmlessly for the rest of your life.

Why is prostate brachytherapy done?

Prostate brachytherapy treats localized prostate cancer that hasn't spread beyond the prostate gland. Your doctor might recommend this treatment if you have early-stage prostate cancer with favorable characteristics, meaning the cancer is likely to respond well to radiation therapy.

This treatment works particularly well for men with low to intermediate-risk prostate cancer. You might be a good candidate if your PSA level is relatively low, your Gleason score indicates slower-growing cancer, and imaging shows the cancer is confined to your prostate.

Brachytherapy offers several advantages over other treatments. It delivers radiation directly to cancer cells while minimizing exposure to surrounding organs like your bladder and rectum. Many men choose this option because it typically requires fewer treatment sessions than external beam radiation and may have fewer long-term side effects.

Your doctor might also recommend combining brachytherapy with external beam radiation for intermediate or high-risk cancers. This combination approach can be more effective than either treatment alone for certain types of prostate cancer.

What is the procedure for prostate brachytherapy?

The brachytherapy procedure typically takes place in an outpatient surgery center or hospital. You'll receive spinal anesthesia or general anesthesia to ensure you're comfortable throughout the process. Most men go home the same day, though some may stay overnight for observation.

Before the actual implantation, your medical team performs careful planning using imaging studies. They'll use ultrasound and sometimes CT or MRI scans to map your prostate's exact size and shape. This planning ensures the seeds are placed in optimal positions to target cancer cells effectively.

During the procedure, you'll lie on your back with your legs in stirrups, similar to a gynecological exam position. Your doctor will insert an ultrasound probe into your rectum to guide the seed placement. They'll then insert thin needles through the skin between your scrotum and anus to reach your prostate.

The radioactive seeds are loaded into the needles and deposited into predetermined locations throughout your prostate. The number of seeds varies depending on your prostate size and cancer characteristics, but typically ranges from 40 to 100 seeds. Each seed placement takes just seconds, and the entire procedure usually lasts one to two hours.

After all seeds are placed, your doctor will use imaging to confirm proper positioning. They may make small adjustments if needed to ensure optimal radiation coverage of your prostate tissue.

How to prepare for your prostate brachytherapy?

Your preparation begins several weeks before the procedure with detailed planning scans. You'll undergo imaging studies to map your prostate's anatomy and determine the optimal seed placement strategy. This planning phase is crucial for treatment success and typically involves both ultrasound and CT imaging.

Your doctor will provide specific instructions about medications and supplements. You may need to stop taking blood-thinning medications like aspirin or warfarin several days before the procedure. Always discuss your complete medication list with your healthcare team, including over-the-counter supplements and herbal remedies.

On the day of your procedure, you'll need to arrange for someone to drive you home. The anesthesia and medication will make it unsafe for you to drive or operate machinery for the rest of the day. Plan to have a responsible adult stay with you for at least the first 24 hours after treatment.

You'll likely receive instructions about bowel preparation, which may include an enema or special diet the day before. Your doctor might also prescribe antibiotics to prevent infection. Follow these instructions carefully to ensure the best possible outcome.

Bring comfortable, loose-fitting clothing to wear home after the procedure. You may experience some discomfort or swelling, so tight-fitting clothes could be uncomfortable. Consider bringing entertainment like books or music for any waiting time.

How to read your prostate brachytherapy results?

Success of prostate brachytherapy is measured through regular PSA blood tests over time. Your PSA level should gradually decrease after treatment, though this process can take months to years. Unlike surgery, where PSA drops immediately, radiation therapy causes a slower, more gradual decline.

Your doctor will monitor your PSA levels every few months initially, then less frequently as time passes. A successful treatment typically shows PSA levels dropping to very low levels, often below 1.0 ng/mL, though individual results vary. Some men experience temporary PSA increases during the first few years, which doesn't necessarily indicate treatment failure.

Imaging studies may be used to assess treatment response, particularly if PSA levels don't decrease as expected. Your doctor might recommend MRI scans or other imaging to evaluate your prostate and surrounding tissues. These tests help determine whether the cancer is responding to treatment.

The radiation from brachytherapy seeds continues working for months after implantation. Most of the radiation dose is delivered within the first few months, but seeds continue emitting lower levels of radiation for up to a year. This extended treatment time is one reason why results are evaluated over months rather than weeks.

Your doctor will also monitor you for any side effects or complications during follow-up visits. They'll assess your urinary function, bowel habits, and sexual health to ensure you're recovering well from treatment.

What are the risk factors for prostate brachytherapy complications?

Certain factors may increase your risk of experiencing side effects from prostate brachytherapy. Understanding these risk factors helps you and your doctor make informed decisions about treatment options and what to expect during recovery.

Pre-existing urinary problems significantly increase your risk of complications. If you already have difficulty urinating, frequent urination, or other prostate-related symptoms, brachytherapy may worsen these issues. Men with large prostates or severe urinary symptoms may experience more pronounced side effects.

Your age and overall health status influence how well you'll tolerate treatment. While brachytherapy is generally well-tolerated, older men or those with multiple health conditions may have a higher risk of complications. Your doctor will evaluate your overall fitness for the procedure during the planning phase.

Previous prostate procedures can affect your risk profile. Men who've had prior prostate surgery, particularly transurethral resection of the prostate (TURP), may have increased risks of urinary complications. Your surgical history helps your doctor anticipate potential challenges.

Prostate size and anatomy play important roles in treatment success and side effect risks. Very large prostates may be more difficult to treat effectively, while certain anatomical features might increase the risk of radiation exposure to nearby organs.

What are the possible complications of prostate brachytherapy?

Most men tolerate prostate brachytherapy well, but understanding potential complications helps you prepare for recovery and know when to contact your healthcare team. Complications can be immediate, occurring within days or weeks, or long-term, developing months or years after treatment.

Urinary complications are the most common side effects you might experience. These can range from mild to more significant issues that affect your daily life:

• Increased urination frequency, especially at night
• Urgency to urinate or difficulty holding urine
• Burning or stinging sensation during urination
• Weak urine stream or difficulty starting urination
• Blood in urine, which usually resolves within a few weeks
• Complete inability to urinate, requiring catheter placement

These urinary symptoms typically peak within the first few months after treatment and gradually improve over time. Most men find their symptoms manageable with medication and lifestyle adjustments.

Bowel complications are less common but can occur due to radiation exposure to the rectum. You might experience changes in bowel habits or discomfort:

• Increased bowel movement frequency
• Rectal urgency or difficulty controlling bowel movements
• Rectal bleeding or irritation
• Hemorrhoids or anal discomfort
• Rare cases of rectal injury requiring medical intervention

Sexual function changes affect many men after brachytherapy, though these effects often develop gradually over months to years. The radiation can affect blood vessels and nerves important for sexual function, leading to erectile dysfunction of varying degrees.

Very rare but serious complications can occur, though they affect less than 1% of men. These might include seed migration to other body parts, severe radiation injury to surrounding organs, or infection at the implantation site.

When should I see a doctor for prostate brachytherapy concerns?

Contact your healthcare team immediately if you experience severe symptoms that could indicate serious complications. Complete inability to urinate is a medical emergency requiring immediate attention. Don't wait to see if this resolves on its own.

Seek prompt medical care if you develop signs of infection or unusual bleeding. Fever, chills, or flu-like symptoms within the first few weeks after treatment could indicate an infection requiring antibiotic treatment.

Call your doctor if you experience these concerning symptoms:

• Severe pain that doesn't improve with prescribed medication
• Heavy bleeding in urine that doesn't decrease over time
• Signs of infection like fever, chills, or excessive pain
• Sudden worsening of urinary symptoms
• Persistent nausea or vomiting
• Severe rectal bleeding or pain

Schedule regular follow-up appointments as recommended by your healthcare team. These visits allow your doctor to monitor your recovery, track PSA levels, and address any concerns before they become serious problems.

Don't hesitate to contact your healthcare team with questions or concerns, even if they seem minor. Your medical team wants to ensure you have the best possible outcome and recovery experience.