Brachytherapy for prostate cancer involves doctors placing radioactive material near a prostate tumor while a person is under anesthetic. Although the method may cure the disease, brachytherapy may cause complications, such as pain and incontinence.
Brachytherapy is a type of radiation therapy where doctors place small radioactive objects near a tumor inside the body. This allows the radiation to kill cancer cells while preserving as many healthy cells as possible.
This article discusses the goals and types of this technique for prostate cancer. It also explains the possible side effects of brachytherapy for prostate cancer and what someone can expect from the treatment.
Brachytherapy is not a suitable treatment for all prostate cancers. According to the
- Early stage, slow-growing cancers: Doctors may recommend brachytherapy on its own for these prostate cancers.
- Cancers with a high probability of spreading beyond the prostate: Doctors sometimes recommend brachytherapy for these cancers, but only alongside external radiation therapy.
Some people cannot have brachytherapy, even if their prostate cancer fits the criteria above. These individuals include:
- people with distant metastases, meaning the cancer has spread beyond the prostate
- people who have a rectal fistula, a tunnel or clump of tissue that affects the anus
- some people with a transurethral resection of the prostate, a surgical procedure that involves removing a section of the prostate
An individual with prostate cancer should discuss their suitability for brachytherapy with a doctor.
There are two main types of brachytherapy for prostate cancer. As the
- Low dose rate (LDR) or permanent brachytherapy: Doctors place small amounts of radioactive material near a prostate tumor. This might be iodine-125, or palladium-103. The material emits low doses of radiation for several weeks until it loses its radioactivity. The pellets can then remain in the prostate.
- High dose rate (HDR) or temporary brachytherapy: During a treatment session, doctors place small amounts of iridium-192 or cesium-137 near the prostate tumor. They remove this material after several minutes, as it emits high doses of radiation. Over 2 days, doctors will perform 1–4 treatment sessions.
For people with earlier stage prostate cancer, brachytherapy aims to kill as many localized cancer cells as possible. At this stage, the method could eliminate prostate tumors and cure the disease.
For people with later stage prostate cancer, brachytherapy does not aim to cure this condition. Instead, it may help prevent the cancer from spreading to other organs.
- inflamed urethra
- urinary retention
- erectile dysfunction
- prolonged catheter usage
- rectal urgency
- urinary incontinence
- rectal fistula, a tunnel that develops from the rectum to the skin’s surface
- bone fractures
Although some complications may improve over time, others can be more permanent. An individual should carefully consider the risks of brachytherapy before opting for this treatment option.
Doctors always perform brachytherapy in an operating room. This is a surgical procedure that requires either local or general anesthesia. After surgery, an individual may need to stay in the hospital overnight.
A person’s experience of brachytherapy will depend on the type they have.
The procedure for an LDR brachytherapy is as follows:
- Doctors place small radioactive pellets inside fine needles.
- They insert those needles through the skin, between the scrotum and anus.
- Once the needles enter the prostate, doctors deposit the radioactive pellets near the tumor. They typically deposit around 100 pellets.
People who have LDR brachytherapy may emit small amounts of radiation for several weeks or months. Doctors may recommend avoiding contact with pregnant people and small children during this time.
Doctors may also recommend a person strains their urine for a week after their procedure to catch any pellets that may migrate to the urinary tract. Using a condom during sex is also advisable.
The procedure for an HDR brachytherapy is as follows:
- Doctors insert thin, hollow needles through the skin, again between the scrotum and anus.
- After the needles enter the prostate, doctors insert small catheters into them before removing the needles. The catheters stay in place and allow doctors to place radioactive materials into the prostate temporarily.
- They may repeat this process over 1–2 days.
- After this, doctors will remove the catheters.
A person does not emit radiation after HDR brachytherapy, so taking the same precautions for LDR is unnecessary.
Once the treatment ends, doctors remove the catheters. A person can
- to have pain-relief medication before a doctor removes the catheter
- some tenderness in the catheter area for a few months
- to avoid strenuous activities for several weeks
After any cancer treatment, an individual will require follow-up care. This
Follow-up care also allows individuals to discuss the side effects of brachytherapy or to anticipate them. For instance, bone density testing means doctors can gauge their patient’s risk of bone fractures and act accordingly.
The goal of brachytherapy is to either cure prostate cancer or slow its growth. Brachytherapy involves doctors placing radioactive substances near a tumor. Because of their proximity to the tumor, these substances can potentially kill more cancer cells than healthy ones.
In LDR, doctors use needles to place radioactive material near a person’s prostate tumor permanently. This material emits low doses of radiation over several weeks or months. After this time, the material is no longer radioactive.
In HDR, doctors use needles to insert catheters into a person’s prostate. They can then place higher doses of radiation near the prostate tumor, but only for several minutes at a time. Doctors may do this 1–4 times over several days.
Brachytherapy is a surgical procedure that requires an anesthetic. Although it can help cure prostate cancer, this treatment may also cause long-term complications.