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Brachytherapy

Prostate brachytherapy involves the placement of radioactive material directly into the prostate gland. These implants can be in the form of wires or radioactive iodine 'seeds'.

The seeds are about the size of a grain of rice and are inserted into the prostate through hollow needles placed through the skin bellow the scrotum. This procedure is generally performed under a general anaesthetic and is called an implant.

Slowly over a few months the seeds deliver a dose of radiation to the prostate cancer.

Criteria for prostate brachytherapy

There are strict guidelines that determine whether you are suitable for brachytherapy. These criteria include:

  • Your level of fitness
  • Your symptoms
  • The size of the prostate gland
  • The local extent of the cancer within the prostate- the cancer must be confined to the gland
  • The aggressiveness of your cancer cells

If brachytherapy is not suitable there are other options for managing your malignancy including external beam radiotherapy and hormone therapy that may be more suitable. Discuss these options with your doctor.

Advantages

Compared to radical prostate surgery, brachytherapy is simple, less invasive, has a shorter recovery time and is less likely to affect urinary incontinence.

Compared to external beam radiotherapy, brachytherapy is less likely to cause long term rectal problems or erectile dysfunction and involves fewer visits to hospital.

Procedure

If your urologist and radiation oncologist have decided that you are suitable for brachytherapy, they will first need to plan your treatment.

Firstly, you will need an ultrasound examination of the prostate. By showing the size and position of the prostate gland, the ultrasound shows precisely where to put the radioactive seeds.

You will then need to return to the hospital in about six weeks after your ultrasound to have the seeds implanted. You will be admitted to the hospital for at least one night after the procedure to ensure that there are no problems with urination.

About three weeks after the implant you will need a CT scan of the prostate; the scan allows doctors to determine the exact dose of radiation given to the prostate.

You will then be followed up every few months when examinations and PSA tests will be done to assess how effective the treatment has been.

Side effects

It is important to realise that side effects may occur from all treatments.

When undergoing the procedure, you will need to undergo at least one general anaesthetic and stay in the hospital at least one night.

The level of radiation emitted by the seeds is very low, but as a precaution it is advised that pregnant women and young children maintain a distance of a metre from you (except for short periods - hugs and cuddles) for the first month after the procedure.

Initially you may have slight bleeding from the needle puncture sites and have swelling or bruising around the scrotum. Applying an ice pack can bring relief and reduce the swelling.

There may be some blood in your urine after your implant, but this generally settles down within a few days. Some men may develop short or long term urinary problems such as obstruction or incontinence. This is more common in men who already have severe urinary difficulties and is why these men are excluded from brachytherapy.

For a few weeks after treatments you may experience some bowel irritation, this may include frequent or loose motions and/or light bleeding from the rectum. These symptoms nearly
always recover.

Also, follow-up tests may indicate that the brachytherapy implant has not adequately treated the gland, thus additional external beam radiation therapy would be recommended.

Other treatments