Brachytherapy for Prostate Cancer

What is a Brachytherapy?

Brachytherapy is a minimally invasive procedure where the doctor implants tiny permanent radioactive seeds (about the size of a grain of rice) into the prostate where they irradiate the cancer from inside the gland. The implanted seeds are small enough that they will not be felt by the patient. Depending on your circumstances, either radioactive Iodine (I -125) or palladium (Pd-103) will be used. Brachytherapy is also referred to as interstitial radiation therapy or seed implant therapy.

What is the purpose of a brachytherapy?

Brachytherapy seed implantation is an effective treatment for men with localized prostate cancer. Brachytherapy is best used for patients with low risk disease and normal sized prostates. Seed implantation requires no surgical incision and offers men a short recovery time. Brachytherapy can be an outpatient procedure, and most men go home the same day as their treatment. Additionally, most men can return to their normal activities a few days after treatment.

What are common symptoms following brachytherapy?

Urinary Side Effect

Urinary side effects are temporary but common for patients undergoing prostate cancer treatment. Brachytherapy side effects may include feelings of urgency, frequent urination, and slower and weaker urinary streams. These urinary side effects occur immediately following the seed implants as well as in the months following, but subside as the radioactive material begins to decay.

Immediately after the seed implants, a patient may feel an immediate sense of urgency. The irritation a patient feels from the surgical procedure tends to subside within two weeks. The feelings of urgency will return shortly after they go away. The radiation of the brachytherapy seeds causes these new side effects. The feeling of urgency will be the strongest when the radiation from the seeds is the strongest, approximately 2-6 weeks after having the implant. Those patients who have undergone brachytherapy seed implants may need to schedule their activities around urination to avoid the discomfort of being caught without a restroom available.

Most patients say that they regain normal pre-operative urinary function within a few months of the brachytherapy implants.

Sex after Brachytherapy

Sexual side effects are also common. Some patients experience erectile dysfunction. Some patients who undergo brachytherapy seed implants also report a shortening of the penis.

The prostate gland and the seminal vesicles are responsible for creating the fluid that makes up semen. Consequently, most men report a decrease in their amount of ejaculation. Some patients report pain with their first ejaculation after the brachytherapy seed implants. The pain, however, subsides with subsequent ejaculations. Ejaculation may also appear red or even brown the first few times, but this discoloration is normal and not cause for alarm.

Seed Migration

Brachytherapy seeds usually stays in place, though minimal seed migration may occur. Seed migration occurs when a brachytherapy seed does not stay in place in the prostate gland and moves to another part of the body. Usually, brachytherapy seeds will migrate to the urethra or bladder, though sometimes a seed may migrate to the lungs. There is no evidence that suggests that the lungs may be affected by a loose brachytherapy seed.

If patients find that they pass a seed during urination, they should use a pair of tweezers to pick up the seed and wrap it tin foil. They should then return the seed to their doctor. If a seed is accidentally flushed down the toilet, the patient should not worry. A seed will not affect a municipal water supply. Patients may also rarely pass seeds during ejaculation.

When should I seek advice from my physician?

You should contact your physician if you develop any of the following:

  1. Fevers that are consistently above 101 degrees Fahrenheit.
  2. Drainage of pus.
  3. Large amounts of continuing bleeding and swelling.
  4. Uncontrolled pain or nausea.
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