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Prostate brachytherapy

Definition

Brachytherapy is a procedure to implant radioactive "seeds" into the prostate gland to kill prostate cancer cells. Implants may be short-term or permanent. They may give off high or low amounts of radiation.

Alternative Names

Implant therapy - prostate cancer; Radioactive seed placement

Description

Brachytherapy takes 30 minutes or more, depending on the type of therapy you have. Before the procedure, you will be given medicine so that you do not feel pain. You may receive:

• A sedative to make you drowsy and numbing medicine on your perineum (the area between your anus and rectum).
• Spinal anesthesia. You will be drowsy but awake, and numb below your waist.
• General anesthesia. You will be asleep and pain free.

After you receive anesthesia:

• Your doctor will place an ultrasound probe into your rectum to see the area. The probe is like a camera connected to a video monitor in the room. Your doctor might also place a Foley catheter (tube) in your bladder to drain urine.
• Your doctor will use ultrasound or a CT scan to place the “pellets” that deliver radiation into your prostate. The pellets will be placed with needles or special applicators through your perineum.
• Placing the pellets may hurt a little.

Types of brachytherapy

• Low-dose brachytherapy is the most common type of treatment. The pellets stay inside your prostate and emit a small amount of radiation for several months. You go about your normal routine with the pellets in place.
• High-dose brachytherapy lasts about 30 minutes. Your doctor will insert the radioactive material into the prostate. The doctor may use a computerized robot. The radioactive material is removed after treatment.

Why the Procedure Is Performed

Brachytherapy is often used for men with smaller prostate cancer that is found early and is slow-growing. Brachytherapy has fewer complications and side effects than standard radiation therapy. You will also need fewer visits with the doctor.

See also: Radical prostatectomy

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Bleeding
• Infection

Risks for this procedure are:

• Urinary problems
• Rectal urgency, or the feeling that you need to have a bowel movement right away
• Skin irritation in your rectum or bleeding from your rectum
• Impotence

Rare problems are ulcers (sores) or fistulas (openings) in the rectum, scarring, and narrowing of your urethra (the tube that carries urine from your bladder out of your body).

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

Before this procedure:

• You may need to have ultrasounds, x-rays, or CT scans to prepare for the procedure.
• You may be asked to stop taking drugs that make it hard for your blood to clot several days before the procedure. Some of these are aspirin, ibuprofen (Advil), clopidogrel (Plavix), and warfarin (Coumadin).
• Ask your doctor which drugs you should still take on the day of the surgery.
• If you smoke, try to stop. Your doctor or nurse can help.

On the day of the procedure:

• You will usually be asked not to drink or eat anything for several hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After an outpatient therapy procedure, you can return home as soon as the anesthesia wears off. Very rarely, you will need to spend 1 to 2 days in the hospital.

If you have a permanent implant, your doctor may tell you to limit the amount of time you spend around children and women who are pregnant for a while after the procedure.

You may be sleepy and have some mild pain and tenderness after the procedure. If you stay in the hospital, your visitors will need to follow special radiation safety precautions.

Outlook (Prognosis)

Most people remain cancer-free or have good control of their cancer for many years after this treatment. Some urinary and rectal symptoms may last for months. One common urinary problem is the inability to empty the bladder and you may need to have a Foley catheter (tube) in place to drain the bladder temporarily.

References

D'Amico AV, Crook J, Beard CJ, DeWeese TL, Hurwitz M, Kaplan I. Radiation therapy for prostate cancer. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 100.

Nelson WG, Carter HB. DeWeese TL, Eisenberger MA. Prostate cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 88.

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