Like all treatments, permanent seed brachytherapy can cause side effects. These will affect each man differently, and you may not get all the possible side effects.
Side effects usually start to appear about a week after treatment, when radiation from the seeds starts to have an effect. They are generally at their worst a few weeks or months after treatment, when the swelling is at its worst and the radiation dose is strongest. They are often worse in men with a large prostate, as more seeds and needles are used during their treatment. Side effects should improve over the following months as the seeds lose their radiation and the swelling goes down.
You might have worse side effects if you have permanent seed brachytherapy together with external beam radiotherapy and hormone therapy.
You might also get more side effects if you had problems before the treatment. For example, if you already had urinary, erection or bowel problems, these may get worse after permanent seed brachytherapy.
After the treatment, you might get some of the following:
- blood-stained urine or rusty or brown-coloured 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 urinate and a need to urinate more often, especially at night, and more urgently.
Some side effects may take several weeks to develop and may last for longer. These may include problems urinating, erection problems, bowel problems and tiredness.
Sometimes bowel, urinary and sexual problems after radiotherapy treatment are called pelvic radiation disease. The Pelvic Radiation Disease Association has more information.
Researchers have been looking at whether smoking increases the chance of having long-term bowel and urinary problems after radiotherapy for prostate cancer. At the moment only a small number of studies have been done, so we need more research into this. If you’re thinking of stopping smoking there’s lots of information and support available on the NHS website.
Permanent seed brachytherapy can irritate the bladder and urethra. You may hear this called radiation cystitis. Symptoms include:
- needing to urinate more often or urgently
- difficulty urinating
- discomfort or a burning feeling when you urinate
- blood in your urine.
In some men, permanent seed brachytherapy can cause the prostate to swell, narrowing the urethra and making it difficult to urinate.
A few men find they suddenly and painfully can’t urinate in the first few days or weeks after treatment. 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.
Urinary problems may be worse in the first few weeks after brachytherapy, especially in men with a large prostate, but they usually start to improve after a few months.
Medicines called alpha-blockers may help with problems urinating. You can also help yourself by drinking liquid regularly (two litres or three to four pints a day) and by avoiding drinks that may irritate the bladder, such as alcohol, fizzy drinks, artificial sweeteners, and drinks with caffeine, such as tea and coffee.
Permanent seed brachytherapy can also cause scarring in your urethra, making it narrower over time. This is called a stricture, and can 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.
Some men leak urine (urinary incontinence) after permanent seed brachytherapy, but this isn’t common. It may be more likely if you’ve previously had surgery to treat an enlarged prostate, called a transurethral resection of the prostate (TURP). Problems with leaking urine may improve with time, and there are ways to manage them.
Read more about urinary problems and how to manage them, or visit our interactive online guide for lots more tips.
Your bowel and back passage are close to the prostate. Permanent seed brachytherapy can irritate the lining of the bowel and back passage, which can cause bowel problems. The risk of bowel problems after permanent seed brachytherapy is low. But you're more likely to have problems if you’re also having external beam radiotherapy.
Bowel problems can 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
- bleeding from the back passage
- feeling that you need to empty your bowels but not being able to go.
Bowel problems tend to be mild and are less common than after external beam radiotherapy. They often get better with time but a few men have problems a few years after treatment. Try not to be embarrassed to tell your hospital doctor or your GP about any bowel problems. There are treatments that can help.
A small number of men may have bleeding from the back passage after brachytherapy. This can also be a sign of other problems such as piles (haemorrhoids) or more serious problems such as bowel cancer, so tell your nurse or GP about any bleeding. They may do tests to find out what is causing it. They can also tell you about treatments that can help.
Using a rectal spacer to protect your back passage
Your doctor or radiographer may suggest using a rectal spacer to help protect the inside of your back passage from radiation damage. The spacer is placed between your prostate and your back passage. This means that less radiation reaches your back passage, which may help to lower your risk of bowel problems.
Rectal spacers aren’t commonly used in permanent seed brachytherapy alone. But you may have one if you’re also having external beam radiotherapy. If your hospital doesn’t use rectal spacers, you may be able to have one through private healthcare or a clinical trial. Ask your doctor, nurse or radiographer for more information.
Screening for bowel cancer
If you’re invited to take part in the NHS bowel screening programme soon after having 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 permanent seed brachytherapy, and this shouldn’t be anything to worry about. But if you notice blood, you should always let your doctor, nurse or radiographer know.
Sexual side effects
Brachytherapy can affect the blood vessels and nerves that control erections. This may cause problems getting or keeping an erection (erectile dysfunction). Erection problems may not happen straight after treatment, but sometimes develop some time afterwards.
The risk of long-term erection problems after brachytherapy varies from man to man. You may be more likely to have problems if you had any erection problems before treatment, or if you are also having hormone therapy or external beam radiotherapy.
If you have anal sex and prefer being the penetrative partner (top) you normally need a strong erection, so erection problems can be a particular issue.
There are ways to manage erection problems, including treatments that may help keep your erection hard enough for anal sex. Ask your doctor or nurse about these, or speak to our Specialist Nurses.
You may produce less semen than before the treatment, or none at all. This can be a permanent side effect of brachytherapy. Your orgasms may feel different or you may get some pain in your penis when you orgasm. You may also notice a small amount of blood in the semen. This usually isn’t a problem, but tell your doctor or nurse if it happens. Some men have weaker orgasms than before treatment, and a small number of men can no longer orgasm afterwards.
If you have anal sex and are the receptive partner (bottom), there’s a risk that your partner might be exposed to some radiation during sex in the first few months after treatment. Your doctor or radiographer may suggest you avoid having anal sex for the first six months. Anal play is unlikely to move the brachytherapy seeds out of the prostate, but ask your doctor, nurse or radiographer for more information about having anal sex after permanent seed brachytherapy. They might be able to give you specific advice about how long to wait before having sex that is tailored to you and your treatment.
If you prefer to be the receptive partner during anal sex, then bowel problems or a sensitive anus after permanent seed brachytherapy may affect your sex life. Even when the risk of radiation to your partner has passed, wait until any bowel problems have improved before trying anal play or sex.
Read more about sexual side effects after prostate cancer treatment. We also have specific information if you're a gay or bisexual man. And there are lots of tips for managing sexual problems in our interactive online guide.
Brachytherapy may make you infertile, which means you may not be able to have children naturally. But some men are still able to make someone pregnant after brachytherapy.
It’s possible that the radiation could change your sperm and this might affect any children you conceive. The risk of this 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 or clinical oncologist for more information.
If you plan to have children in the future, you may be able to store your sperm before you start treatment so that you can use it later for fertility treatment. If this is relevant to you, ask your doctor, nurse or radiographer whether sperm storage is available locally.
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 fatigue. For example, planning your day to make the most of when you have more energy. Read more about fatigue, or get tips for dealing with fatigue in our interactive online guide. Our Specialist Nurses also offer a fatigue support service that can help you improve your fatigue over time.