Permanent seed brachytherapy, also known as low dose-rate brachytherapy, involves having tiny radioactive seeds implanted in your prostate gland. Radiation from the seeds destroys cancer cells in the prostate. You may be suitable for this treatment if your cancer is thought to be contained within the prostate gland (localised prostate cancer) and:

 

 

If you have a PSA of between 10 and 20, and a Gleason score of 7, this treatment may still be an option for you as long as tests show that the cancer is unlikely to have spread outside of the prostate. Check with your doctor or nurse. It may not be suitable if you have a large prostate gland, severe problems passing urine, or have recently had an operation called a transurethral resection of the prostate (TURP).

You may have this treatment on its own or together with external beam radiotherapy and/or hormone therapy. It is just as good at controlling prostate cancer as other treatments.

There is another type of brachytherapy called temporary brachytherapy or high
dose-rate (HDR) brachytherapy. It is less common than permanent seed brachytherapy.

 

What other treatments are available?

 

 

 

 

 

 

 

 Watch's Chris' story for one man's experience of brachytherapy.

 

 

 

 

 

 

 

 

 

What are the advantages and disadvantages?

Advantages

  • You will be in hospital for just one or two days for the treatment.
  • Recovery is quick so most men can return to their normal activities a couple of days after treatment.
  • You will have a shorter period of anaesthetic with brachytherapy compared with surgery as the procedure is quicker. This means you may recover more quickly from the anaesthetic.
  • The radiation is inside the prostate gland and does not travel far, so there may be less damage to the surrounding areas.
  • There may also be less damage to the blood vessels and nerves that control erections than after other prostate cancer treatments.

Disadvantages

  • Brachytherapy can cause side effects such as urinary, bowel and erection problems.
  • It requires one or two anaesthetics, depending on the method used. Anaesthetic can have side effects.
  • It may be some time before you will know whether the treatment has been successful. 

What might be an advantage for one person may not be for someone else. You can talk to your doctor or nurse about your own situation.

What does treatment involve?

You will have a planning session to measure the size and position of your prostate to work out how many radioactive seeds you need. This is also a final check that the treatment is suitable for you. You may have a general anaesthetic so that you are asleep during the procedure, or you could have a spinal or epidural anaesthetic, so that you are awake but cannot feel anything.

The radioactive seeds will either be implanted on the same day as the planning session (one-stage procedure) or they will be implanted two to four weeks later (two-stage procedure). You will have a general anaesthetic or you may have a spinal or epidural anaesthetic.

Brachytherapy - Where the seeds go

You will have a computerised tomography (CT) or magnetic resonance imaging (MRI) scan four to six weeks after the treatment to check the position of the seeds. You will have regular follow-up appointments after this to monitor your PSA level and any side effects. If your treatment has been successful, your PSA level should drop, although it may start to rise again because your prostate will still produce some PSA. Some men may experience a rise and fall in PSA at around one to two years after treatment.

You can read more about what treatment involves in our Permanent seed brachytherapy fact sheet.

What are the side effects?

You may not have any side effects for several days until the radiation from the seeds begins to take effect. Side effects are generally at their worst a few weeks after treatment, when the radiation dose is strongest, but should then improve over the following months as the seeds lose their radiation.

The most common side effects are:

  • Blood-stained urine or discoloured semen for a few days or weeks.
  • Bruising and pain in the area between your testicles and back passage which can spread to your inner thighs and penis. This will disappear in a week or two.
  • Discomfort when you pass urine and needing to pass urine more often, especially at night.
  • Problems passing urine, erection problems, bowel problems and tiredness.

Side effects will affect each man differently, and you may not get all of the side effects.

Some men who have had brachytherapy and external beam radiotherapy together may find that they have worse side effects. If you already had urinary, erection or bowel problems before treatment, these may be worse after treatment.

Questions to ask your doctor or nurse

  • Which type of permanent seed brachytherapy will I have? The one-stage or two-stage procedure?
  • Will I have external beam radiotherapy as well as brachytherapy?
  • What are the chances of side effects such as urinary problems, erection problems and bowel problems with this treatment?
  • How will I know if the treatment has worked?
  • What should my PSA level be after treatment and how often will you measure it?
  • If my PSA continues to rise, what other treatments are available?

References

  • Full list of references used to produce this page  

    1. National Institute for Health and Clinical Excellence. Low dose rate brachytherapy for localised prostate cancer. Interventional Procedure Guidance 132. 2005
    2. Kupelian PA, Potters L, Khuntia D et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. International Journal of Radiation Oncology, Biology, Physics 2004; 58(1):25-33.
    3. Wilt TJ, MacDonald R, Rutks I, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localised prostate cancer. Annals of Internal Medicine 2008; 148(6): 435-48.
    4. Colberg JW, Decker RH, Khan AM, et al. Surgery versus implant for early prostate cancer: results from a single institution, Cancer Journal 2007; 13 (4): 229-32.
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    6. Bannuru RR, Dvorak T, Obadan N et al. Comparative evaluation of radiation treatments for clinically localized prostate cancer: an updated systematic review. Annals of Internal Medicine 2011; 155 (3): 171-78.
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    17. Royal College of Physicians. The effects of cancer treatments on reproductive functions. Guidance on Management. Report of a Working Party 2007. Available at: http://www.rcr.ac.uk/docs/oncology/pdf/Cancer_fertility_effects_Jan08.pdf
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