Permanent seed brachytherapy
Page summary
Permanent seed brachytherapy is a type of internal radiotherapy that involves putting tiny radioactive seeds into the prostate to destroy cancer cells.
You can have permanent seed brachytherapy on its own or with external beam radiotherapy or hormone therapy depending on your cancer stage and the risk of your cancer spreading.
Permanent seed brachytherapy may work as well as surgery or external beam radiotherapy in some men, with a lower risk of some side effects.
In some men, permanent seed brachytherapy may help hormone therapy or external beam therapy work better.
What is permanent seed brachytherapy?
Permanent seed brachytherapy, also known as low dose-rate (LDR) brachytherapy, is a type of internal radiotherapy where tiny radioactive seeds are put into your prostate. Each radioactive seed is the size and shape of a grain of rice.
How does it work?
The seeds stay in the prostate forever and give out a steady dose of radiation over a few months.
The radiation damages the prostate cells and stops them dividing and growing. The cancer cells can't recover from this damage and die. But healthy cells can repair themselves more easily.
The seeds release most of their radiation in the first three months after they’re put into the prostate. After around 8 to 10 months, almost all the radiation has gone. The amount of radiation left is so small that it doesn’t have an effect on your body.
For low-risk localised prostate cancer, permanent seed brachytherapy in its own works as well as surgery (radical prostatectomy) or external beam radiotherapy. Read more about other treatment options for localised prostate cancer.
There is another type of brachytherapy called high dose-rate brachytherapy, also called temporary brachytherapy. This involves thin needles which pass down a source of radiation into the prostate for a few minutes. The source of radiation is then removed, so no radiation is left in the body.
Download or order our permanent seed brachytherapy fact sheet
Who can have permanent seed brachytherapy?
Permanent seed brachytherapy is suitable for some men with localised or locally advanced prostate cancer. It may be given on its own or alongside other treatments, depending on the risk of your cancer spreading (your Cambridge Prognostic Group or CPG). Read more about what your test results mean.
Permanent seed brachytherapy on its own
If you have localised prostate cancer that has a low risk of spreading, you can have permanent seed brachytherapy on its own. You may hear your doctor describe your cancer as being in Cambridge Prognostic Group (CPG) 1 or 2, which means it has a low risk of spreading outside the prostate.
Some men can have permanent seed brachytherapy on its own if they have medium-risk localised prostate cancer (CPG 3). But we don’t have as much evidence about how well it works on its own for this type of prostate cancer. Or you might be offered permanent seed brachytherapy with other treatments.
Permanent seed bracytherapy with other treatments
If you have localised prostate cancer that has a higher risk of spreading (CPG 4 or 5), or locally advanced prostate cancer, you may have it alongside external beam radiotherapy or hormone therapy (or both).
This is called a brachytherapy boost. There’s evidence that it can make the other treatments more effective, but there is an increased risk of side effects.
If you've had a transurethral resection of the prostate (TURP)
If you’ve had a transurethral resection of the prostate (TURP) – a type of surgery used to treat an enlarged prostate, you may have to wait at least three months to allow the area to recover.
If the opening created by the TURP is too large, then permanent seed brachytherapy might not be suitable.
When might permanent seed brachytherapy not be suitable?
Permanent seed brachytherapy may not be suitable:
If your prostate cancer has spread to other parts of your body (advanced prostate cancer). This is because the radiation from the seeds does not travel far and will only treat the cancer inside your prostate.
If your prostate is large. But some men can have hormone therapy to shrink their prostate first.
If you have problems urinating (weeing), such as those caused by an enlarged prostate or overactive bladder, then brachytherapy could make these problems worse.
If you have some types of inflammatory bowel disease (IBD), as it could make your bowel problems worse.
If you’ve had surgery to remove your rectum (back passage), as the treatment involves putting an ultrasound probe into the back passage.
If you're not well enough to have a general anaesthetic.
Not all hospitals offer brachytherapy, but you can be referred to one that does. This may mean you need to travel for your treatment
What are the advantages and disadvantages?
What may be important to one man might be less important to someone else. If you’re offered permanent seed brachytherapy, speak to your doctor or nurse before deciding whether to have it. They can help you choose the right treatment for you.
There’s a list of questions at the end of this page that you might find helpful. There’s usually no rush to make a decision, so give yourself time to think about whether permanent seed brachytherapy is right for you.
If you’re having external beam radiotherapy or hormone therapy as well as permanent seed brachytherapy, think about the advantages and disadvantages of those treatments as well.
Recovery is quick. Most men can return to their normal activities one or two days after treatment.
By putting radioactive seeds straight into the prostate, a higher dose of radiation can be focused on the cancer cells while reducing the impact on nearby organs, like the bladder and bowel.
With less damage to surrounding healthy tissue, there is a lower risk of some side effects, including urinary incontinence and erection problems.
You will only be in hospital for one or two days.
If your cancer comes back, you can still have further treatment.
It can cause side effects such as urinary and erection, and bowel problems.
It may be some time before you know whether the treatment has been successful.
You will need a general or spinal anaesthetic, which can have side effects.
The level of radiation given out by the seeds is low and you’re not a risk to the general public. But for the first two months, avoid a lot of close physical contact with children, pregnant women and pets. Read more about radiation safety.
What does the treatment involve?
You will be referred to a specialist in radiotherapy treatment (a clinical oncologist), or to a urologist who specialises in brachytherapy.
Other specialists may also be involved, including a radiographer, a radiologist, a urologist, a physicist and a specialist nurse. The seeds will be placed by the oncologist or urologist.
Each hospital may do things slightly differently, but you will usually have:
an appointment to check if the treatment is suitable
a planning session
the treatment itself.
Your first appointment
At your first appointment, you’ll usually have a scan to check the size of your prostate and find out how many seeds you’ll need. This is called a volume study.
If the scan shows that your prostate is too large, you may be offered hormone therapy for up to six months to shrink your prostate before the treatment.
Very occasionally, the scan may show that permanent seed brachytherapy isn’t possible because of the position of your prostate within the pelvic bones. If this happens, the specialist will discuss other treatment options with you.
Two to three weeks later, you’ll have the planning session.
Before the planning session, let your specialist know if you are taking any medicines, especially medicines that thin your blood such as aspirin, warfarin or clopidogrel. Don’t stop taking any medicines without speaking to your doctor or nurse.
Planning session
Most hospitals do the planning session and put in the seeds on the same day. This is called a one-stage procedure. Some hospitals do the planning session and treatment on separate days. This is called a two-stage procedure.
The planning session usually takes about half an hour. During the planning session, you will have a transrectal ultrasound (TRUS). This is where an ultrasound probe is put inside your back passage and attached to a machine. A detailed image of your prostate is then displayed on a screen. This helps to work out exactly where to put the seeds.
You may need to take a medicine (a laxative) the day before the planning session, or you’ll be given an enema at the hospital to empty your bowels. This will help to get a clear image of your prostate during the scan.
You will usually have a general anaesthetic, so you will be asleep during the scan. If you can’t have one for health reasons, then you may be able to have a spinal (epidural) anaesthetic. This is where anaesthetic is injected into your spine so that you can’t feel anything from the waist down.
You might also have a catheter put in. This is a thin tube that is passed up your urethra (the tube you urinate through) to drain urine from your bladder.
You can go home on the same day if you’re not having the treatment straight away. Ask a friend or family member to take you home, as you shouldn’t drive for at least 24 hours after an anaesthetic.
Placing the seeds
If you have the treatment on the same day as your planning session, the seeds will be put in straight after the scan, under the same anaesthetic.
If you have the treatment on a different day, you’ll need another anaesthetic on the day of the treatment. You might also need to take another laxative or have another enema to empty your bowels.
Depending on the size of your prostate, between 60 and 120 seeds are put into the prostate using around 15 to 30 needles. The seeds can be loose individual seeds or linked in a chain using material that slowly dissolves. The type of seed you have will depend on the hospital.
The treatment usually takes 45 to 90 minutes. During the treatment, an ultrasound probe will be put inside your back passage again to help make sure the seeds are put in the right place. In some hospitals, the doctor will put gel into your urethra instead of a catheter, so they can see your urethra more clearly and avoid putting any seeds into it.
The oncologist or urologist will then put long thin needles through your perineum (the area between the testicles and back passage) and into your prostate. The radioactive seeds are passed through the needles and into the prostate. The needles are then taken out, leaving the seeds behind.
Where the seeds go in the prostate
After your treatment
You’ll remain in hospital for at least a few hours after the treatment. After the procedure, you’ll wake up from the anaesthetic in the recovery room, before going back to the ward or discharge area.
Most men feel fine after a general anaesthetic, but a few men feel sick or dizzy. Your nurse may give you an ice pack to put between your legs to help prevent swelling.
If you had a catheter put in, it will usually be removed before you wake up). But it may be left in for a few hours until you’re fully awake. Very rarely, you might go home with your catheter in and come back a few days later to have it removed. Having the catheter removed may be uncomfortable, but it shouldn’t be painful.
You can go home once you’ve recovered from the anaesthetic and can pass urine. Most men go home on the same day. But some men find it difficult to urinate at first and may need to stay in hospital overnight. You shouldn’t drive for 24 hours after the anaesthetic. Ask a family member or friend to take you home.
Your doctor or nurse will give you any medicines that you need at home. These may include drugs to help you urinate, such as tamsulosin, and antibiotics to prevent infection. You may have some pain, bruising and bleeding from the area where the needles were put in. Take pain-relieving drugs, such as paracetamol, for the first few days.
When to call your doctor, nurse or radiographer
Your doctor, nurse or radiographer will give you a telephone number to call if you have any questions or concerns. Contact them if any of the following things happen.
If your urine is very bloody or has large clots in it, you may have some bleeding in your prostate. Contact your doctor or nurse as soon as possible.
If you suddenly and painfully can’t urinate, you may have acute urine retention. Go to your local accident and emergency (A&E) department, as this will need treatment as soon as possible. Take information about your cancer treatment with you, if you can.
If you have a high temperature (more than 38ºC or 101ºF), this may be a sign of infection. Contact your doctor or nurse, or go to your local A&E department.
What happens after the treatment?
Radiation safety
The prostate and surrounding pelvis absorb most of the radiation. It’s safe for you to be around other people. But for the first two months after treatment, avoid being closer than 50 cm (20 inches) to children for more than a few minutes a day.
You can give them a quick cuddle (at chest level), but avoid having them on your lap. You should also avoid being this close to pregnant women for long periods of time (more than three hours).
This is because these groups are more sensitive to radiation, but the overall risk is still very low. There are no restrictions on using public transport.
If you have pets, try not to let them sit on your lap for the first two months.
It's also important to know that if a man dies, for whatever reason, in the first 20 months after having permanent seed brachytherapy, it won't be possible to have a cremation because of the radioactive seeds.
Speak to your doctor or nurse if you're worried about this. Some men decide not to have the treatment because of this – for personal or religious reasons.
Advice card
You'll be given an advice card that says you’ve had treatment with permanent seed brachytherapy. You should carry this with you for at least 20 months – especially when you travel.
If the seeds move or come out
Although the seeds usually stay in the prostate, it's possible for them to move or come out. This is most likely to happen in the first month after treatment, so it should be picked up when you have a scan at your follow-up appointment.
It's very rare, but a seed could come out when you urinate. You might feel slight discomfort if you pass a seed, but it’s more likely you’ll just see it in the toilet.
If this happens in hospital, leave the seed where it is and let the hospital staff know straight away.
If this happens after you’ve left hospital, don’t try to pick it up. Just flush it down the toilet. If it falls outside the toilet bowl, pick it up using a spoon or tweezers with a long handle, and flush it down the toilet.
It's also very rare for them to come out in your semen when you ejaculate. But to be on the safe side, don’t have sex for a few days after treatment, and use a condom the first five times you ejaculate. Double-wrap used condoms and put them in the bin.
Always tell your doctor, nurse or radiographer if you think you have passed a seed. Your treatment will still work because there will still be enough radiation left in the prostate to treat your cancer.
Another rare possibility is that a seed moves into your bloodstream and travels to another part of your body. But this has not been found to do any harm as the amount of radiation released is so small.
Going back to normal activities
You should be able to return to your normal activities after a few days.
You can go back to work as soon as you feel able. This will depend on how much physical effort your work involves. It’s best to avoid heavy lifting for a few days after having the seeds put in.
Speak to your doctor, nurse or radiographer about your own situation.
Travelling after permanent seed brachytherapy
Remember to take your advice card with you when you travel. Most airports and seaports have radiation detectors that can be very sensitive. Your seeds may set them off, even though the radiation levels are low. You can show your card to staff to help explain why this has happened.
Speak to your doctor, nurse or radiographer if you plan to travel anywhere soon after having permanent seed brachytherapy, or if you have any concerns about holidays and travel plans.
Read more about travel and prostate cancer.
Your follow-up appointment
You’ll have an appointment with your doctor, nurse or radiographer four to six weeks after your treatment. They will check how well you’re recovering, your PSA level (see below), and ask about any side effects.
You might also have a CT or MRI scan to check the position of the seeds. This can happen on the same day as your treatment, but it may be up to six weeks adter your treatment, depending on your hospital.
Read more about follow-up after treatment.
PSA blood test
At most hospitals, you’ll have a PSA test six weeks after your treatment. Then, for the next two to three years, you'll have a PSA test at least every six months, and then at least once a year after that.
Each hospital does things slightly differently, so ask your doctor or nurse how often you'll have a PSA test.
How long will it take for my PSA level to fall?
Your PSA level should steadily drop over the next five years. How quickly it falls, and how low it goes, varies from man to man. It also depends on the size of your prostate and whether you’re also having hormone therapy. It won’t fall to zero because healthy prostate cells produce some PSA.
Your PSA level may rise after your treatment, then fall again. This is called a ‘PSA bounce’ and it usually happens within 18 months, but it can happen up to three years after treatment. It's more common in younger men and men with a large prostate.
A PSA bounce is normal and doesn’t mean your cancer has come back, or that you need more treatment.
If your PSA level keeps rising, particularly in a short amount of time, this could be a sign that the cancer has come back. If this happens, your doctor will talk to you about further tests and further treatments. You can also contact our Specialist Nurses for information and support.
Looking after yourself after permanent seed brachytherapy
Some hospitals don’t offer as many follow-up appointments as others. Instead, you may be encouraged to take greater control of your own health and wellbeing. You might hear this called supported self-management.
This may mean talking to your doctor or nurse over the telephone, rather than having appointments at the hospital.
You’ll still have regular PSA blood tests to check how your cancer has responded to treatment (see above). But your GP may give you the results over the phone or in a letter.
Some men prefer this type of follow-up, as it means you can avoid going to appointments when you’re feeling well and don’t have any concerns. Your doctor or nurse will also give you details of who to call if you have any questions or concerns.
Side effects affect each man differently, and you might not get all of them.
They usually start about a week after the treatment, when radiation from the seeds starts to have an effect.
You might notice bruising in the area between your testicles and back passage, which may spread to your inner thighs and penis. This should disappear in a week or two.
Side effects such as problems urinating, erection problems, bowel problems and fatigue, can take several weeks to develop and may last longer. They are generally at their worst a few weeks or months after treatment, when the swelling is at its worst.
Over the following months, these side effects should improve as the seeds lose their radiation and the swelling goes down.
It’s rare, but some men develop long-term or late side effects after radiotherapy treatment. This is called pelvic radiation disease. If you’re worried about this, there’s more information on the Pelvic Radiation Disease Association website.
What are the side effects of permanent seed brachytherapy?
The main side effects of permanent seed brachytherapy are:
Side effects affect each man differently, and you might not get all of them. They usually start about a week after the treatment, when radiation from the seeds starts to have an effect.
After treatment, you might notice bruising in the area between your testicles and back passage, which may spread to your inner thighs and penis. This should disappear in a week or two.
Side effects such as problems urinating, erection problems, bowel problems and fatigue, can take several weeks to develop and may last longer. They are generally at their worst a few weeks or months after treatment, when the swelling is at its worst. Over the following months, these side effects should improve as the seeds lose their radiation and the swelling goes down.
You might experience worse side effects if:
You have a large prostate. This is because more seeds and needles will be used.
You’re having permanent seed brachytherapy in combination with external beam radiotherapy or hormone therapy.
If you already have urinary, erection or bowel problems, these might get worse after permanent seed brachytherapy.
You smoke. There is some evidence that smoking increases the risk of long-term bowel and urinary problems after external beam radiotherapy, but we need more research to know if this includes permanent seed brachytherapy. Smoking may also increase the chance of cancer coming back afterwards. If you want to stop smoking, there’s lots of information and support available on the NHS website.
Some men develop long-term or late side effects after radiotherapy treatment but this is rare. This is called pelvic radiation disease and there’s more information on the Pelvic Radiation Disease Association website.
Permanent seed brachytherapy can irritate the bladder and urethra. This is called radiation cystitis. Symptoms include:
difficulty urinating
needing to urinate more often or urgently, especially at night
discomfort or a burning feeling when you urinate
blood-stained urine or rusty or brown-coloured semen for a few days or weeks.
Difficulty urinating
In some men, permanent seed brachytherapy can cause the prostate to swell, narrowing the urethra and making it difficult to urinate in the first few days or weeks after treatment. This is more likely if you have brachytherapy combined with external beam radiotherapy.
A few men may find they suddenly and painfully can’t urinate at all. This is called acute urine retention. If this happens, contact your doctor or nurse straight away, or go to your nearest accident and emergency (A&E) department as soon as possible. They may need to put in a catheter to drain the urine. You may need to have the catheter in for several weeks until your symptoms have settled down.
The treatment can also cause scarring in the urethra, making it narrower over time. This is called a stricture, and can also make it difficult to urinate. This is rare and may happen several months or years after treatment. If it happens, you might need an operation to widen your urethra or the opening of the bladder.
How long might I have urinary problems for?
Urinary problems may be worse in the first few weeks after treatment, especially in men with a large prostate. They usually start to improve after a few months. Most men will have recovered after a year.
What can help with urinary problems?
The following may help you manage any urinary problems.
Medicines called alpha-blockers.
Drinking liquid regularly (two litres or three to four pints a day).
Avoiding drinks that may irritate the bladder, such as alcohol, fizzy drinks, artificial sweeteners, and drinks with caffeine, such as tea and coffee.
Will I leak urine (urinary incontinence)?
Some men experience urinary incontinence after permanent seed brachytherapy, but this is rare. It may be more likely if you’ve previously had a TURP.
Read more about urinary problems after prostate cancer treatment.
Permanent seed brachytherapy can irritate the lining of the bowel and back passage, which can cause bowel problems. But bowel problems after permanent seed brachytherapy tend to be mild and the risk is low.
You are more likely to have bowel problems if you’re also having external beam radiotherapy. You might have a rectal spacer to help protect your bowel.
What is a rectal spacer?
A rectal spacer is a gel that is placed between your prostate and back passage to help protect your back passage from radiation. In some men, it may lower the risk of bowel problems. But it can have side effects.
Rectal spacers aren’t available at all hospitals. Ask your doctor, nurse or radiographer for more information.
What bowel problems might I have?
Bowel problems may include:
loose and watery bowel movements (diarrhoea)
passing more wind than usual
needing to empty your bowels more often
needing to empty your bowels urgently
feeling that you need to empty your bowels but not being able to go.
A small number of men may have bleeding from the back passage. But this can also be a sign of other problems, such as piles (haemorrhoids), or more serious problems such as bowel cancer.
Tell your nurse or GP about any bleeding. You may have tests to find out what’s causing it. They can also tell you about treatments and diet changes that may help. Read more about bowel problems on our website.
Screening for bowel cancer
If you’re invited to take part in the NHS bowel screening programme soon after having permanent seed brachytherapy, the test may pick up some blood in your bowel movements, even if you can’t see any blood yourself.
Your doctor, nurse or radiographer may suggest that you delay your bowel screening test for a few months if you’ve recently had brachytherapy. This will help to make sure you don’t get incorrect results.
A small number of men get blood in their bowel movements after the treatment. This shouldn’t be anything to worry about. But if you do notice blood, you should always let your doctor, nurse or radiographer know.
Permanent seed brachytherapy can affect the blood vessels and nerves that control erections. This may cause problems getting or keeping an erection (erectile dysfunction).
For some men, erection problems may not happen straight away but can develop several months later. Men who do get erection problems usually experience them within the first three years after treatment.
The risk of long-term erection problems after brachytherapy varies from man to man. You may be more likely to have them if you had problems in the past, or if you’re also having hormone therapy or external beam radiotherapy.
There are many treatments for erection problems, including taking PDE5 inhibitors (phosphodiesterase type 5 inhibitors). Speak to your doctor about your treatment options.
Other sexual side effects you might experience include:
You may produce less or no semen.
You may notice a little blood in your semen for a few months. This is not usually a problem and should go away in a few weeks, but tell your doctor or nurse if there is a lot.
You can still orgasm but it may feel different. A small number of men can no longer orgasm.
You may feel pain in your penis when you ejaculate, especially soon after the seeds have been inserted. Tell your doctor or nurse if this happens.
Read more about prostate cancer and your sex life.
If you have anal sex or anal play
If you have anal sex and prefer being the penetrative partner, then erection problems can be a particular issue. There are ways to manage this, including treatments that may help keep your erection hard enough for penetrative sex.
Your doctor may suggest that you avoid receiving anal sex or anal play for the first six months after permanent seed brachytherapy. If you have bowel problems or a sensitive anus, you may also want to wait until these have improved. Ask your doctor about how long.
Find out more in our information for gay and bisexual men.
Having children
Permanent seed brachytherapy can make some men infertile, which means you will not be able to have children naturally. But some men are stil able to make someone pregnant after permanent seed brachytherapy. It’s possible that the radiation could change your sperm and this might affect any children you conceive.
The risk of this happening is very low, but use contraception for at least a year after treatment if there’s a chance you could get someone pregnant. Ask your doctor for more information about this.
If you plan to have children in the future, you can store your sperm before you start treatment so that you can use it later for fertility treatment. Sperm can usually be stored for up to 10 years, sometimes longer. Ask your doctor for more information.
You may feel tired for the first few days after treatment as you recover from the anaesthetic. The effect of radiation on the body may make you feel tired for longer, especially if you’re also having external beam radiotherapy or hormone therapy.
If you get up a lot during the night to urinate, this can also make you feel tired during the day.
Fatigue is extreme tiredness that can affect your everyday life. It can affect your energy levels, motivation and emotions. Fatigue can continue after the treatment has finished and may last several months.
There are things you can do to help manage your fatigue, such as planning your day to make the most of when you have more energy.
Our Specialist Nurses also offer support that can help you improve your fatigue over time.
Questions to ask your doctor, nurse or radiographer
Will I have a planning session at a different time to the treatment, or immediately before?
Will I have external beam radiotherapy or hormone therapy as well?
What side effects might I get?
How will we 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 and reviewers
Updated: September 2026 | Due for Review: September 2029
Andersen MF, Midtgaard J, Bjerre ED. Do Patients with Prostate Cancer Benefit from Exercise Interventions? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Jan;19(2):2. doi:10.3390/ijerph19020972
Andreyev HJN. GI Consequences of Cancer Treatment: A Clinical Perspective. Radiat Res. 2016 Mar 28;185(4):341–8. doi:10.1667/RR14272.1
Awad MA, Gaither TW, Osterberg EC, Murphy GP, Baradaran N, Breyer BN. Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2018 Jun;21(2):168–74. doi:10.1038/s41391-017-0028-3
Bownes P, Coles I, Doggart A, Kehoe T. UK Guidance on Radiation Protection Issues following Permanent Iodine- 125 Seed Prostate Brachytherapy [Internet]. 2012. Available from: https://www.ipem.ac.uk/ScientificJournalsPublications/UKGuidanceonRadiationProtectionIssuesfollowi.aspx
Chao MWT, Grimm P, Yaxley J, Jagavkar R, Ng M, Lawrentschuk N. Brachytherapy: state-of-the-art radiotherapy in prostate cancer. BJU Int. 2015 Oct;116:80–8. doi:10.1111/bju.13252
Chen RC, Basak R, Meyer AM, Kuo TM, Carpenter WR, Agans RP, et al. Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer. JAMA. 2017 Mar 21;317(11):1141–50. doi:10.1001/jama.2017.1652
Corey G, Yoosuf ABM, Workman G, Byrne M, Mitchell DM, Jain S. UK & Ireland Prostate Brachytherapy Practice Survey 2014-2016. J Contemp Brachytherapy. 2018;10(3):238–45. doi:10.5114/jcb.2018.76839
Cornford et al. EAU Guidelines on Prostate Cancer - Uroweb [Internet]. 2026 [cited 2026 Mar 23]. Available from: https://uroweb.org/guidelines/prostate-cancer
Cornu JN, Gacci M, Hashim H, Herrmann TRW, Malde S, Netsch C, et al. EAU Guidelines on Non Neurogenic Male LUTS [Internet]. European Association of Urology; 2025 [cited 2025 Jul 8]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Non-Neurogenic-Male-LUTS-2025.pdf
Dovey Z, Horowitz A, Waingankar N. The influence of lifestyle changes (diet, exercise and stress reduction) on prostate cancer tumour biology and patient outcomes: A systematic review. BJUI Compass. 2023;4(4):385–416. doi:10.1002/bco2.237
Foerster B, Pozo C, Abufaraj M, Mari A, Kimura S, D’Andrea D, et al. Association of Smoking Status With Recurrence, Metastasis, and Mortality Among Patients With Localized Prostate Cancer Undergoing Prostatectomy or Radiotherapy: A Systematic Review and Meta-analysis. JAMA Oncol. 2018 Jul 1;4(7):953–61. doi:10.1001/jamaoncol.2018.1071
Frazzoni L, La Marca M, Guido A, Morganti AG, Bazzoli F, Fuccio L. Pelvic radiation disease: Updates on treatment options. World J Clin Oncol. 2015 Dec 10;6(6):272–80. doi:10.5306/wjco.v6.i6.272 PubMed PMID: 26677440; PubMed Central PMCID: PMC4675912.
Ghaffar U, Abbasi B, Li KD, Venishetty N, Hakam N, Fernandez A, et al. Ejaculatory function after radiotherapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2025 Sep;28(3):572–7. doi:10.1038/s41391-024-00882-4
Gianotten WL. Sexual aspects of shared decision making and prehabilitation in men diagnosed with prostate cancer. Int J Impot Res. 2021 May;33(4):397–400. doi:10.1038/s41443-020-00404-5
Guy’s and St Thomas’ NHS Foundation Trust [Internet]. [cited 2026 Jul 13]. How drinks affect your bladder and bowel - Overview. Available from: https://www.guysandstthomas.nhs.uk/health-information/how-drinks-affect-your-bladder-and-bowel
Hamblen AJ, Bray JW, Hingorani M, Saxton JM. Physical activity and dietary considerations for prostate cancer patients: future research directions. Proc Nutr Soc. 2023 Sep;82(3):298–304. doi:10.1017/S0029665123000046
Henry A, Pieters BR, Siebert FA, Hoskin P. GEC-ESTRO ACROP prostate brachytherapy guidelines. Radiother Oncol. 2022 Feb 1;167:244–51. doi:10.1016/j.radonc.2021.12.047 PubMed PMID: 34999134.
Human Fertilisation & Embryology Authority (HFEA). Human Fertilisation & Embryology Authority (HFEA) [Internet]. [cited 2025 Aug 6]. Sperm freezing. Available from: https://www.hfea.gov.uk/treatments/fertility-preservation/sperm-freezing/
Hunt AA, Choudhury KR, Nukala V, Nolan MW, Ahmad A, Ashcraft KA, et al. Risk of erectile dysfunction after modern radiotherapy for intact prostate cancer. Prostate Cancer Prostatic Dis. 2021 Mar;24(1):128–34. doi:10.1038/s41391-020-0247-x
Huyghe E, Delannes M, Wagner F, Delaunay B, Nohra J, Thoulouzan M, et al. Ejaculatory Function After Permanent 125I Prostate Brachytherapy for Localized Prostate Cancer. Int J Radiat Oncol. 2009 May;74(1):126–32. doi:10.1016/j.ijrobp.2008.07.064
Ishiyama H, Hirayama T, Jhaveri P, Satoh T, Paulino AC, Xu B, et al. Is There an Increase in Genitourinary Toxicity in Patients Treated With Transurethral Resection of the Prostate and Radiotherapy?: A Systematic Review. Am J Clin Oncol. 2014 Jun;37(3):297–304. doi:10.1097/COC.0b013e3182546821
Jassem J. Tobacco smoking after diagnosis of cancer: clinical aspects. Transl Lung Cancer Res. 2019 May;8(S1):S50–8. doi:10.21037/tlcr.2019.04.01
Johnson EE, Mamoulakis C, Stoniute A, Omar MI, Sinha S. Conservative interventions for managing urinary incontinence after prostate surgery. Cochrane Database Syst Rev. 2023;2023(4). doi:10.1002/14651858.cd014799.pub2
King MT, Keyes M, Frank SJ, Crook JM, Butler WM, Rossi PJ, et al. Low dose rate brachytherapy for primary treatment of localized prostate cancer: A systemic review and executive summary of an evidence-based consensus statement. Brachytherapy. 2021 Nov;20(6):1114–29. doi:10.1016/j.brachy.2021.07.006
Kishan A, Kupelian P. Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects. Brachytherapy. 2014;14(2):148–59.
Kubo K, Wadasaki K, Kimura T, Murakami Y, Kajiwara M, Teishima J, et al. Clinical features of prostate-specific antigen bounce after 125I brachytherapy for prostate cancer. J Radiat Res (Tokyo). 2018 Sep 1;59(5):649–55. doi:10.1093/jrr/rry059
Kwon WA, Lee SY, Jeong TY, Moon HS. Lower Urinary Tract Symptoms in Prostate Cancer Patients Treated With Radiation Therapy: Past and Present. Int Neurourol J. 2021 Jun 30;25(2):119–27. doi:10.5213/inj.2040202.101
Langley SEM, Laing RW. 4D Brachytherapy, a novel real-time prostate brachytherapy technique using stranded and loose seeds. BJU Int. 2012;109(s1):1–6. doi:10.1111/j.1464-410X.2011.10824.x
Langley SEM, Soares R, Uribe J, Uribe-Lewis S, Money-Kyrle J, Perna C, et al. Long-term oncological outcomes and toxicity in 597 men aged ≤60 years at time of low-dose-rate brachytherapy for localised prostate cancer. BJU Int. 2018;121(1):38–45. doi:10.1111/bju.13946
Lardas M, Liew M, van den Bergh RC, De Santis M, Bellmunt J, Van den Broeck T, et al. Quality of Life Outcomes after Primary Treatment for Clinically Localised Prostate Cancer: A Systematic Review. Eur Urol. 2017 Dec;72(6):869–85. doi:10.1016/j.eururo.2017.06.035
Lehto US, Tenhola H, Taari K, Aromaa A. Patients’ perceptions of the negative effects following different prostate cancer treatments and the impact on psychological well-being: a nationwide survey. Br J Cancer. 2017 Mar 28;116(7):864–73. doi:10.1038/bjc.2017.30
Lippens J, Willems L, Boychak O, Pinkawa M, Orio PF, Chao MWT, et al. Implantable Rectal Spacers in Prostate Cancer Radiation Therapy: A Systematic Review. Pract Radiat Oncol. 2025 Sep 1;15(5):e460–83. doi:10.1016/j.prro.2025.03.009 PubMed PMID: 40246071.
Lischalk JW, Blacksburg S, Mendez C, Repka M, Sanchez A, Carpenter T, et al. Stereotactic body radiation therapy for the treatment of localized prostate cancer in men with underlying inflammatory bowel disease. Radiat Oncol. 2021 Dec;16(1):126. doi:10.1186/s13014-021-01850-1
Luo YH, Yang YW, Wu CF, Wang C, Li WJ, Zhang HC. Fatigue prevalence in men treated for prostate cancer: A systematic review and meta-analysis. World J Clin Cases. 2021 Jul 26;9(21):5932–42. doi:10.12998/wjcc.v9.i21.5932
Maletzki P, Schwab C, Markart P, Engeler D, Schiefer J, Plasswilm L, et al. Late seed migration after prostate brachytherapy with Iod-125 permanent implants. Prostate Int. 2018 Jun;6(2):66–70. doi:10.1016/j.prnil.2017.09.003
Mazzone E, Mistretta FA, Knipper S, Palumbo C, Tian Z, Pecoraro A, et al. Long-Term Incidence of Secondary Bladder and Rectal Cancer in Patients Treated with Brachytherapy for Localized Prostate Cancer: A Large-Scale Population-Based Analysis. BJU Int. 2019 May 30. doi:10.1111/bju.14841
McInnis MK, Pukall CF. Sex After Prostate Cancer in Gay and Bisexual Men: A Review of the Literature. Sex Med Rev. 2020 Jul;8(3):466–72. doi:10.1016/j.sxmr.2020.01.004
Michalski J, Mutic S, Eichling J, Ahmed SN. Radiation exposure to family and household members after prostate brachytherapy. Int J Radiat Oncol. 2003 Jul;56(3):764–8. doi:10.1016/S0360-3016(03)00002-6
Morris KA, Haboubi NY. Pelvic radiation therapy: Between delight and disaster. World J Gastrointest Surg. 2015 Nov 27;7(11):279–88. doi:10.4240/wjgs.v7.i11.279 PubMed PMID: 26649150; PubMed Central PMCID: PMC4663381.
Morris WJ, Tyldesley S, Rodda S, Halperin R, Pai H, McKenzie M, et al. Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT Trial): An Analysis of Survival Endpoints for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost to a Dose-Escalated External Beam Boost for High- and Intermediate-risk Prostate Cancer. Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):275–85. doi:10.1016/j.ijrobp.2016.11.026 PubMed PMID: 28262473.
Muraki K, Nakiri M, Purysko AS, Hattori C, Suefuji H, Suekane H, et al. Permanent Prostate Brachytherapy Placement: Imaging Assessment of Seed Positioning, Spacer Use, and Complications. RadioGraphics. 2025 Dec 1;45(12):e250051. doi:10.1148/rg.250051
National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. NICE Guideline 131 [Internet]. 2021. Available from: https://www.nice.org.uk/guidance/ng131/resources/prostate-cancer-diagnosis-and-management-pdf-66141714312133
National Institute for Health and Clinical Excellence. Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer [Internet]. 2023. Available from: https://www.nice.org.uk/guidance/ipg752
Nguyen DD, Berlin A, Matthew AG, Perlis N, Elterman DS. Sexual function and rehabilitation after radiation therapy for prostate cancer: a review. Int J Impot Res. 2021 May;33(4):410–7. doi:10.1038/s41443-020-00389-1
Niwa K, Iinuma K, Nakano M, Tomioka M, Ito M, Mori T, et al. Secondary primary tumors following iodine-125 low-dose-rate brachytherapy for localized prostate cancer. Int J Clin Oncol. 2026 Mar 29. doi:10.1007/s10147-026-03020-3
Nolsøe AB, Jensen CFS, Østergren PB, Fode M. Neglected side effects to curative prostate cancer treatments. Int J Impot Res. 2021 May;33(4):428–38. doi:10.1038/s41443-020-00386-4
Nugent TS, Low EZ, Fahy MR, Donlon NE, McCormick PH, Mehigan BJ, et al. Prostate radiotherapy and the risk of secondary rectal cancer—a meta-analysis. Int J Colorectal Dis. 2022 Feb;37(2):437–47. doi:10.1007/s00384-021-04075-6
Numakura K, Kobayashi M, Muto Y, Sato H, Sekine Y, Sobu R, et al. The Current Trend of Radiation Therapy for Patients with Localized Prostate Cancer. Curr Oncol. 2023 Aug 31;30(9):8092–110. doi:10.3390/curroncol30090587
Peinemann F, Grouven U, Bartel C, Sauerland S, Borchers H, Pinkawa M, et al. Permanent Interstitial Low-Dose-Rate Brachytherapy for Patients with Localised Prostate Cancer: A Systematic Review of Randomised and Nonrandomised Controlled Clinical Trials. Eur Urol. 2011 Nov;60(5):881–93. doi:10.1016/j.eururo.2011.06.044
Ralph S. Developing UK Guidance on How Long Men Should Abstain from Receiving Anal Sex before, During and after Interventions for Prostate Cancer. Clin Oncol. 2021 Dec;33(12):807–10. doi:10.1016/j.clon.2021.07.010
Razdan S, Pandav K, Altschuler J, Moody K, Martin L, Patel HD, et al. Impact of exercise on continence in prostate cancer patients post robotic assisted radical prostatectomy: a systematic review. Am J Clin Exp Urol. 2023 Aug 15;11(4):320–7. PubMed PMID: 37645610; PubMed Central PMCID: PMC10461030.
Royal College of Radiologists. Quality assurance practice guidelines for transperineal LDR permanent seed brachytherapy of prostate cancer. 2012.
Solanki AA, Liauw SL. Tobacco use and external beam radiation therapy for prostate cancer: Influence on biochemical control and late toxicity: Prostate Radiation Toxicity in Smokers. Cancer. 2013 Aug 1;119(15):2807–14. doi:10.1002/cncr.28128
Sterling J, Rahman SN, Varghese A, Angulo JC, Nikolavsky D. Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease. J Clin Med. 2023 Jun 9;12(12):3950. doi:10.3390/jcm12123950
Stish BJ, Davis BJ, Mynderse LA, McLaren RH, Deufel CL, Choo R. Low dose rate prostate brachytherapy. Transl Androl Urol. 2018 Jun;7(3):341–56. doi:10.21037/tau.2017.12.15 PubMed PMID: 30050795; PubMed Central PMCID: PMC6043740.
St-Laurent, MP, et al. Long-Term Second Malignancies in Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy and Radical Prostatectomy | Journal of Urology. J Urol [Internet]. 2024 Apr 29 [cited 2026 May 18]. Available from: https://www.auajournals.org/doi/10.1097/JU.0000000000003965
Tran S, Boissier R, Perrin J, Karsenty G, Lechevallier E. Review of the Different Treatments and Management for Prostate Cancer and Fertility. Urology. 2015 Nov;86(5):936–41. doi:10.1016/j.urology.2015.07.010
Trotta M, Patel KR, Singh S, Verma V, Ryckman J. Safety of Radiation Therapy in Patients With Prostate Cancer and Inflammatory Bowel Disease: A Systematic Review. Pract Radiat Oncol. 2023 Sep;13(5):454–65. doi:10.1016/j.prro.2023.04.006
Uribe-Lewis S, Uribe J, Bourke V, Deering C, Higgins D, Mehta S, et al. Long-term survival after low-dose-rate brachytherapy for prostate cancer: the Royal Surrey experience. BJU Int. 2022;129(6):723–30. doi:10.1111/bju.15585
Uribe-Lewis S, Uribe J, Deering C, Langley S, Higgins D, Whiting D, et al. Net survival of men with localized prostate cancer after LDR brachytherapy. Brachytherapy. 2024 May;23(3):329–34. doi:10.1016/j.brachy.2024.02.006
Wang L, Wu L, Qian C, Ju Y, Liu T, Chen Y, et al. The Beneficial Effect of a Healthy Dietary Pattern on Androgen Deprivation Therapy-Related Metabolic Abnormalities in Patients with Prostate Cancer: A Meta-Analysis Based on Randomized Controlled Trials and Systematic Review. Metabolites. 2022 Oct 13;12(10):969. doi:10.3390/metabo12100969
Warli S, Ikram MF, Kadar D, Siregar G, Prapiska F, Laksmi LI, et al. The Radical Prostatectomy Versus Brachytherapy for the Management of Low- and Intermediate-Risk Prostate Cancer: A Meta-Analysis of Observational Studies Focusing on Oncological Outcomes. Asian Pac J Cancer Prev. 2026 Jan 1;27(1):233–48. doi:10.31557/APJCP.2026.27.1.233
Wedlake LJ. Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy. Proc Nutr Soc. 2018 Nov;77(4):357–68. doi:10.1017/s0029665118000101
White ID. Sexual Difficulties after Pelvic Radiotherapy: Improving Clinical Management. Clin Oncol. 2015 Nov;27(11):647–55. doi:10.1016/j.clon.2015.06.018
Wolff RF, Ryder S, Bossi A, Briganti A, Crook J, Henry A, et al. A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer. Eur J Cancer. 2015 Nov;51(16):2345–67. doi:10.1016/j.ejca.2015.07.019
Yuan F, Wang Y, Xiao X, Zhang X, Jing M, Kamecki H, et al. A systematic review evaluating the effectiveness of exercise training on physical condition in prostate cancer patients undergoing androgen deprivation therapy. Transl Androl Urol. 2023 Aug 31;12(8):8. doi:10.21037/tau-23-272
Zaorsky NG, Shaikh T, Murphy CT, Hallman MA, Hayes SB, Sobczak ML, et al. Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer. Cancer Treat Rev. 2016 Jul;48:50–60. doi:10.1016/j.ctrv.2016.06.006
This publication was written and edited by our Health Information team.
It was reviewed by:
Peter Bownes, Consultant Clinical Scientist, Leeds Teaching Hospitals NHS Trust
Richard Gledhill, Prostate Cancer Nurse Specialist, University Hospitals Birmingham
Ann Henry, Clinical Oncologist, Leeds Teaching Hospitals NHS Trust
Stephen Langley, Clinical Urologist, Royal Surrey Cancer Centre & NHS Hospital
Our Specialist Nurses
Our volunteers.
