Prostate Brachytherapy
Frequently Asked Questions

Brachytherapy is a form of internal radiation in which small radiation sources (commonly called seeds) are permanently implanted, via needles, in a cancerous area of the prostate. Brachytherapy has long been an option for the treatment of cervical, breast, head and neck cancers. Brachytherapy for prostate cancer gained prominence in the 1970s and has re-emerged as a promising cancer treatment due to technological advancements in ultrasound imaging and computerized tomography (CT).

Brachytherapy is a site-specific method of delivering high doses of radiation to cancerous areas. Following are some of the possible benefits and advantages of brachytherapy:

• Minimally invasive procedure
• May not require hospital stay
• As effective as other therapies
• Little to no effect on patient's lifestyle and level of activity
• Less likely to develop impotence than other treatment options

In general, prostate brachytherapy procedures take one to three hours and can be performed on an outpatient basis, which means an overnight hospital stay usually isn't necessary.

If your physician chooses to preplan your seed implantation, approximately a few days before your implantation you will be required to undergo a series of standard tests, such as a blood test, an EKG and chest X-rays.

In addition, your physician may perform an ultrasound study approximately two weeks before your surgery that will show your doctor the exact shape, size and location of your prostate. The data from this study will help your doctor determine how many radiation seeds you require and where they should be placed. To further prepare for your procedure, your doctor will use the ultrasound study to create an "implantation map" that will be used as a guide during your prostate brachytherapy procedure.

You will be placed under spinal or general anesthesia and an ultrasound or fluoroscopy probe will be inserted into your rectum. This probe will give your doctor continual visualization of your prostate. Using this probe and the implantation map created prior to your procedure, your doctor will use needles to insert 60-120 brachytherapy radiation seeds into targeted areas of your prostate gland.

Your doctor will provide you with postimplantation guidelines to follow that are specific to your individual case. You can expect to experience some slight bleeding and tenderness around your implantation site, as well as slight bleeding and burning when you urinate. Your urination stream also may be weaker and you may have to urinate more frequently. Your doctor can prescribe medications to help reduce these symptoms; and he or she can provide you with a more detailed description of what physical changes to expect after your procedure.

Unless your doctor recommends a special diet, you should be able to eat your normal meals. Your doctor also may recommend that you avoid strenuous activity for two days to two weeks after your procedure. After the time specified by your doctor, you should be able to return to your normal activity level.

Below is a list of precautions your doctor may ask you to take the first few months after your procedure.

• Do not let children sit on your lap.
• Avoid prolonged contact with pregnant women closer than six feet.
• Use a condom during intercourse because you many discharge seeds in your ejaculate.

Though the seeds are intended to stay in your body, don't be alarmed if they are discharged through your urine flow or ejaculate. Because they are radioactive, the seeds must be recovered if this occurs. Your physician will tell you how to do this and provide you with any additional radiation precautions you should follow.

Here are some possible long-term side effects associated with prostate brachytherapy you should be aware of:

• Depending on age, 10 - 30% of men will become impotent compared to 40-60% with external beam radiation therapy, and 65% - 90% with the standard radical surgery.
• Urinary incontinence and proctitis (inflammation of the rectum) have been reported in less than 1% of all cases.
• Transient dysuria and increased urinary frequency have been reported in about 15% of patients.

Yes. However, be sure to check with your insurance provider for specific details about your coverage for prostate brachytherapy procedures.