Prostate Brachytherapy Procedure
Overview
Prostate brachytherapy is a type of internal radiation therapy that treats prostate cancer. This treatment delivers radiation directly inside the prostate to kill cancer cells while sparing most nearby healthy tissue. There are two main methods for this therapy:
| Type | Description | Duration |
|---|---|---|
| Temporary high dose (HDR) | Doctors place radioactive material in the prostate for a few minutes and then remove it. | A few minutes per session |
| Permanent low dose (LDR) | Doctors leave small radioactive seeds in the prostate, which slowly release radiation over time. | Several months |
Both methods provide direct internal treatment, unlike external beam radiation therapy, which delivers radiation from outside the body. Doctors may combine brachytherapy with other cancer treatments, depending on the patient’s needs. This approach treats cancer with less impact on healthy organs compared to many external options.
Reasons for Choosing This Treatment
Doctors commonly use prostate brachytherapy to treat prostate cancer when the cancer is still in the prostate and has not spread widely. By placing radioactive material directly inside the prostate, the treatment focuses most of the radiation on the cancer and minimizes impact on healthy tissues nearby.
For early and less aggressive prostate cancer:
- May be the only needed treatment
For larger or more aggressive prostate cancer:
- Doctors may use it along with external radiation.
- Sometimes they pair it with hormone therapy to increase effectiveness.
Doctors usually avoid brachytherapy if the cancer has moved to the lymph nodes or other areas of the body.
Possible Risks
Frequently Observed Reactions
Prostate brachytherapy can cause a range of reactions affecting both urinary and bowel function. Some people develop issues with urination, such as trouble starting, frequent or urgent need to go, pain, or blood in the urine. Others may have swelling or feel their bladder is not empty after urinating.
Sexual health can be affected, with problems like difficulty getting or keeping an erection. Bowel side effects may include more frequent trips to the bathroom, urgent needs, blood in the stool, or mild rectal bleeding. Doctors may use different medications to manage discomfort and reduce these signs.
Uncommon but Serious Issues
Rarely, some people develop more severe complications. These can include narrowing of the urethra, which makes it hard to pass urine, or a fistula, which is an unusual connection between the bowel and other organs. In a small number of cases, radiation exposure may cause new cancers in the bladder or rectum.
| Side Effect Type | Possible Issues |
|---|---|
| Urinary | Pain, urgency, trouble starting, blood, incomplete emptying |
| Sexual | Erectile dysfunction |
| Bowel | Blood, urgency, frequency |
| Rare | Urethral narrowing, fistula, secondary cancers |
Steps to Get Ready
Before prostate brachytherapy, people meet with a radiation oncologist to discuss treatment options. This doctor explains what will happen during the procedure and reviews possible benefits and risks. The patient and doctor make a shared decision about the treatment.
Preparation often includes several tests. The treatment team orders blood work and heart exams to confirm the patient is healthy enough for anesthesia. A treatment planning team, which may include a urologist and a radiation oncologist, uses imaging scans like MRI and CT scans to check the prostate gland’s size and exact position.
The scans help the doctors plan where to place the radioactive seeds and decide the proper dose of radiation. This planning usually happens before or at the start of the procedure.
What You Might Experience
Radioactive Seed Implants (LDR Method)
In the low-dose rate version, doctors use anesthesia to keep the patient comfortable and unaware. They place an ultrasound probe in the rectum to view clear images of the prostate. Using these images, doctors insert a thin needle through the skin between the scrotum and the anus (perineum).
Doctors place small radioactive pellets, called seeds, throughout the prostate using this needle. These seeds, about the size of rice grains, emit low levels of radiation that target the prostate tumor over several months. The seeds remain in the body permanently, but the radiation fades over time.
After doctors place the seeds, the patient stays in a recovery area for observation. Most people can go home the same day since doctors usually perform this as an outpatient procedure. Even though the seeds emit only a small amount of radiation, doctors may advise patients to avoid close contact with young children and pregnant women for a short period. They may also recommend using a condom during intimacy.
Key Features
| Step | Description |
|---|---|
| Anesthesia | Patient is not awake or feeling pain. |
| Imaging | Ultrasound probe gives live images of the prostate. |
| Seed Placement | A needle carries radioactive seeds into the prostate. |
| Type of Material | Radioactive pellets, also called seeds. |
| Recovery and Care | Short stay in a recovery room, home the same day. |
Short-Term High-Dose Radiation (HDR Method)
For high-dose rate treatment, doctors place thin tubes called applicators through the perineum while the patient is under anesthesia. They use live imaging to guide the tubes into the correct part of the prostate.
During each treatment session, a machine sends strong radioactive wires into these tubes. The wires remain in place for several minutes to deliver a high dose of radiation. Patients may hear quiet clicking sounds from the machine during this process.
Doctors remove the radioactive material at the end of each session. Depending on the specific plan, doctors may repeat this a few times before removing the tubes. Because the radioactive source does not stay in the body after treatment, patients do not need to take special steps to protect others after leaving the clinic.
Important Points
- The patient is asleep or numb and feels no pain.
- Thin tubes are used to guide radioactive wires.
- Radioactive wires stay in place for minutes, not permanently.
- No radiation remains in the body after treatment.
- Several treatments may be planned.
What Happens Afterwards
After either type of brachytherapy, mild pain or swelling between the legs (perineum) can occur. Applying an ice pack or taking approved pain medicines helps with discomfort. Patients should follow their doctor’s advice and avoid strenuous activities or heavy lifting for a few days.
Most people return to regular activities when they feel better. Recovery instructions from the doctor help the healing process and prevent problems. Patients should call the care team if pain worsens or if they have any questions.
Common Aftercare Steps
- Rest after the procedure.
- Use ice packs for swelling.
- Take medication as directed.
- Limit strenuous activity for a short time.
- Follow instructions from healthcare providers.
Strategies When PSA Levels Go Up After Prostate Radiation Implants
After receiving prostate brachytherapy, people usually have regular blood tests to monitor prostate-specific antigen (PSA) levels. A temporary rise in PSA, sometimes called a “PSA bounce,” can happen and often does not indicate cancer returning. Still, doctors monitor levels closely, especially if PSA keeps going up.
A PSA that stays high after brachytherapy could mean that prostate cancer has come back. To understand the situation better, doctors may order imaging tests and possibly a prostate biopsy. Doctors aim to determine if the cancer remains in the prostate or has spread to other areas. Below is a table with possible next steps if PSA keeps increasing:
| Cancer Location | Treatment Options |
|---|---|
| In the prostate | Cryotherapy, high-intensity focused ultrasound, or salvage surgery (removal of the prostate) |
| Spread beyond gland | Hormone therapy and other systemic approaches |
The treatment choice depends on the Gleason score, patient health, and where the cancer is.
