Brachytherapy for Prostate Cancer: What Is It and More - Healthline

• Brachytherapy is a highly effective treatment for people with very low-, low-, and intermediate-risk prostate cancer.
• Brachytherapy has few side effects.
• This treatment can improve outcomes in people who receive external beam radiation therapy (EBRT) for intermediate- to high-risk prostate cancer.

Treatment for prostate cancer has a high success rate, especially if healthcare professionals catch the cancer in the early stages. Brachytherapy is a form of radiation therapy that targets the site of the cancer.

There are two major types:

• high-dose rate (HDR) brachytherapy
• low-dose rate (LDR) brachytherapy

In both cases, the procedure is minimally invasive and offers strong prospects for a full recovery.

Healthline has partnered with Northwell Health Cancer Institute to bring you more information about how healthcare professionals use brachytherapy to treat prostate cancer.

Brachytherapy is a form of radiation treatment. During brachytherapy, doctors take small particles or "seeds" that contain a source of radiation and place them inside the body in or near a tumor.

The radioactive material only affects the tissue very close to it, so it tackles the tumor but doesn't harm the rest of the body.

According to the American College of Surgeons (ACS), healthcare professionals may recommend brachytherapy as a stand-alone treatment if you have very low- or low-risk prostate cancer or favorable intermediate-risk prostate cancer.

If you have a higher-risk case, healthcare professionals might use brachytherapy in addition to external beam radiation therapy (EBRT).

Procedure

Before the brachytherapy procedure, you'll either receive spinal anesthesia, which numbs your lower body, or general anesthesia, which makes you sleep. You may have to stay in the hospital for a few hours or overnight.

During the procedure, doctors use a needle to place small tubes called catheters into the prostate. They insert the needles through the area between the scrotum and anus.

From this point onward, the treatments for the two types of brachytherapy for prostate cancer look somewhat different from each other.

One is a short-term, high-dose therapy that happens over a few days. The other is a long-term, low-dose treatment that involves therapy over weeks or months. Here's a more detailed description of each.

High-dose rate (HDR) brachytherapy

This form of brachytherapy, also called temporary brachytherapy, delivers a high dose of radiation over a short period of time.

After healthcare professionals insert needles into the prostate, they remove the needles and leave the catheters in place.

Then they put radioactive material inside the catheters. This stays inside the catheters and emits radiation into the prostate for about 5 to 15 minutes. Afterward, the healthcare professionals remove the radioactive material.

Depending on your treatment plan, you may receive one to four such sessions a day over the course of 2 days.

This treatment gives you a concentrated dose of radiation over a short period of time.

Northwell Health is one of the largest cancer institutes in the New York metropolitan area. Their multidisciplinary team of specialists provides a suite of specialized therapies for prostate cancer, including HDR brachytherapy.

Low-dose rate (LDR) brachytherapy

LDR brachytherapy is also called permanent brachytherapy.

The method healthcare professionals use to insert the radioactive material into the prostate is the same for LDR brachytherapy as for HDR brachytherapy — by catheter into the prostate.

LDR differs from HDR brachytherapy in that the radioactive seeds stay inside the body permanently after the catheters are removed.

The seeds give off low-dose radiation over the following weeks or months. The radiation from the seeds doesn't move too far. In this way, it targets the tumor without affecting the surrounding areas.

Eventually, the radioactive material in the seeds will run out. These inert seeds stay in the body permanently. The number of seeds needed depends on the prostate size, but it's usually about 100.

Brachytherapy has a high success rate for prostate cancer.

A 2018 study tracked outcomes for 757 people who received LDR brachytherapy for localized prostate cancer between 1990 and 2006.

The study found a 17-year prostate cancer-specific survival (PCSS) rate of 97 percent.

According to the ACS, the addition of brachytherapy to EBRT improves outcomes compared with EBRT alone. Brachytherapy increases the 9-year success rate from 62 percent to 83 percent for those with intermediate to high-risk cancer.

The overall outlook for people with prostate cancer, regardless of treatment plan, is excellent.

According to the American Cancer Society, the 5-year relative survival rate for people with localized or regional prostate cancer is almost 100 percent.

You'll have follow-up visits with your doctor to check the status of the cancer and monitor your healing.

Before you leave the hospital, you'll receive information about managing symptoms following the procedure. Here are some steps you can take:

• Rest and avoid strenuous activity.
• Take warm baths for pain and swelling.
• Avoid sex for 1 to 2 weeks.
• Drink water.
• Avoid caffeine, soda, and fizzy drinks.
• Take medications for pain, diarrhea, or constipation as your doctor recommends.

Brachytherapy causes the body to give off radiation, according to the National Cancer Institute.

During your treatment, your medical team will have to follow safety protocols. You may have to stay in a private room, and the team may limit the frequency and duration of their contact with you.

Safety protocols extend to your visitors, including friends and family. If you receive a high dose of radiation, your loved ones may not be able to visit when the treatment starts.

As treatment goes on and radiation levels go down, visitors might only be allowed short visits.

When you leave the hospital, you may have to follow safety protocols for a while. For example, you may need to keep a distance from children and those who may be pregnant.

There are some common side effects of both kinds of brachytherapy. These usually get better over time. They include:

• pain and swelling at or near the injection site
• frequent urination
• burning sensation during urination
• traces of blood in urine
• inability to pass urine
• painful ejaculation
• blood in semen
• constipation
• diarrhea
• loose stools
• fatigue

If you can't pass urine at all, contact your emergency department or see your doctor right away. They can drain the urine and advise you further during recovery.

Brachytherapy can cause long-term side effects. Not everyone will experience side effects, but there may be temporary or long-term changes in bowel, urinary, and erectile function.

• Bowel changes: more frequent stools, loose stools, inflammation of the rectum
• Urinary changes: problems passing urine, frequent urination, and in rare cases urethral stricture, which is the closing off of the urethra
• Erectile changes: erectile dysfunction

If you experience any of these side effects, tell your doctor. They may be able to treat some side effects, including urethral stricture and erectile dysfunction.

If you receive low-dose brachytherapy, there's a small risk the seeds in your prostate will move.

Your doctor will provide guidance to guard against this risk. You may have to strain your urine through a filter for about a week to catch seeds if they come out as you're urinating. You may also need to wear a condom during sex.

There's no risk of seed movement with high-dose brachytherapy because the doctor removes the radioactive material right after the procedure.

A PSA test measures prostate-specific antigen (PSA) levels in the blood. Benign enlargement of the prostate, inflammation of the prostate, and prostate cancer can all cause a high PSA.

PSA levels sometimes rise after brachytherapy. However, your doctor won't recommend further cancer treatment based on this test alone. They'll look for a rising trend in PSA over time and consider other factors, such as imaging tests, before recommending further treatment.

Even if your doctor can't see cancer cells with imaging, they may recommend you undergo treatment again based on a risk-benefit analysis. The benefit of catching all the cancer may outweigh the risk of additional treatment.

Brachytherapy is a highly effective treatment for people with very low- to intermediate-risk prostate cancer. This treatment may also improve your outcome if you have intermediate- to high-risk prostate cancer and are receiving EBRT.

The long-term outlook for people who get brachytherapy for prostate cancer is excellent.

If you have prostate cancer, your doctor can tell you what treatments are available to you. Together, you can find a treatment plan for your particular circumstances that's best for your long-term health.