Prostate Brachytherapy

What is prostate brachytherapy?

Prostate brachytherapy, often referred to as “seed implants”, translated from Latin literally means “short therapy”. The seeds, which are about the size of a grain of rice, are implanted directly into the prostate delivering the radiation over “short” distances. This allows for large doses of radiation to be delivered to the prostate with very low doses delivered to surrounding tissues such as bladder and rectum.

What does the procedure involve?

Prostate brachytherapy is usually performed under anesthesia as an outpatient procedure. It takes approximately an hour and is performed under transrectal ultrasound guidance. The brachytherapy team consists of a radiation oncologist, urologist, an anesthesiologist, a physicist and a very highly trained operating room staff.

Under transrectal ultrasound guidance, the prostate is visualized and images are transferred to a special planning computer in the operating room. A real time, adaptive plan is generated by the radiation oncologist and physicist. No surgical incision is required; instead, the radioactive seeds are inserted into the prostate gland using needles which pass through the skin between the scrotum and the rectum (the perineum) and the ultrasound is used to accurately guide them to their final position. The needles are put into the target positions and the seeds are placed into the prostate. The number of seeds placed varies according to each individual prostate size. The needles are then removed. Prior to removal of the ultrasound probe, the special computer software program is used to make sure the prostate gland is completely covered by just the right dose of radiation to ensure that all cancer cells present in the prostate have been completely treated.

What are the indications for prostate brachytherapy?

Prostate brachytherapy is a very effective treatment for prostate cancer that is confined to the prostate. You should have a thorough conversation with your doctor to determine your specific eligibility.

What can I expect after the procedure?

Prostate brachytherapy is a very effective treatment for early, localised prostate cancer, with patients rapidly returning to normal activities. Immediately after brachytherapy, almost all patients have some degree of urinary irritative/obstructive symptomatology with acute urinary retention in 2% to 22% of cases (this number drops to <2% after five days). Medications are used to alleviate these symptoms. There is a 5% to 12% risk of urethral stricture formation up to five years post-treatment which is easily managed by a small procedure (dilatation). Rectal complications consist primarily of mild proctitis which usually resolves spontaneously. Long-term bowel dysfunction is relatively uncommon. The rates of erectile dysfunction (ED) vary based on pre-existing ED and medical comorbidities. Most men, however, respond to phosphodiesterase inhibitor therapy.

What are the outcomes after prostate brachytherapy?

Many studies show prostate brachytherapy to be equal in outcome to surgery in the treatment of prostate cancer. One study showed that even in men less than 60 the 10-year freedom from progression for patients presenting with low, intermediate and high risk disease was 91.3%, 80.0% and 70.2% compared to 91.8%, 83.4% and 72.1%, respectively, for men 60 years of age or older (Shapiro et al. J Urol. 2009 Apr;181(4):1665-71).