Introduction
Prostate brachytherapy is one of the most precise ways to treat prostate cancer. This minimally invasive treatment places radiation sources right into or near the prostate gland. Unlike external radiation, which passes through healthy tissue, brachytherapy puts radiation exactly where it’s needed. This approach kills cancer cells while causing less damage to nearby healthy parts.
Prostate cancer affects millions of men worldwide. Over 1.4 million new cases are found each year. As treatments improve, brachytherapy has become a key option. It offers high cure rates with often fewer side effects than other treatments for the right patients.
This guide covers everything about prostate brachytherapy. We’ll explain the types, procedures, success rates, and side effects. Our goal is to help patients and families better understand this treatment choice.
What Is Prostate Brachytherapy?
Brachytherapy comes from Greek, meaning “short” or “close.” The name fits because radiation sources are placed directly inside or next to the prostate.
Types of Prostate Brachytherapy
There are two main types:
- Low-Dose-Rate (LDR) Brachytherapy
- Tiny radioactive “seeds” are placed in the prostate
- Seeds stay there permanently, with radiation slowly fading away
- Common radioactive materials include Iodine-125, Palladium-103, and Cesium-131
- Delivers radiation over weeks or months
- High-Dose-Rate (HDR) Brachytherapy
- Temporary placement of a strong radiation source
- Delivered through tubes inserted into the prostate
- The source is removed after treatment
- Usually given in 1-4 sessions
- Often combined with external radiation
Doctors choose the best approach based on cancer stage, prostate size, age, and other health factors.
Who Should Get Prostate Brachytherapy?
Not every prostate cancer patient is right for brachytherapy. Choosing the right patients is key for best results.
Good Candidates
Brachytherapy works best for men with:
- Early-stage prostate cancer (T1-T2a)
- PSA levels under 10 ng/mL
- Gleason score of 6 or 7 (3+4)
- Prostate smaller than 60cc
- Few urinary problems
Who Should Consider Other Options
Brachytherapy may not work well for men who:
- Have very large prostates
- Have major urinary issues
- Had previous prostate surgery
- Have advanced cancer (though it might be combined with other treatments)
- Have serious health problems that make anesthesia risky
Dr. Peter Grimm, Director of the Prostate Cancer Treatment Center, says: “Picking the right patient is key. For the right man, brachytherapy offers excellent cancer control with better quality of life, but it’s not for everyone.”
How the Procedure Works
The brachytherapy process involves several steps. The exact steps differ slightly depending on whether you’re getting LDR or HDR brachytherapy.
Before the Procedure
Getting ready involves:
- First Meeting and Check-up
- Review of your health history and medicines
- Physical exam including digital rectal exam
- Review of your imaging and biopsy results
- Volume Study
- Ultrasound to measure your prostate size
- Creation of a 3D model for planning
- Figuring out seed quantity and placement (for LDR)
- Getting Ready
- Stop blood thinners (usually 5-7 days before)
- Bowel prep (typically an enema)
- Instructions about food and drink before procedure
LDR Brachytherapy Procedure
The LDR procedure follows these steps:
- Anesthesia
- Done under general or spinal anesthesia
- You’ll be positioned similar to having a colonoscopy
- Imaging Guidance
- Ultrasound probe inserted to see the prostate
- Real-time imaging ensures correct seed placement
- Seed Placement
- Grid template placed against the skin between scrotum and rectum
- Hollow needles inserted through template into prostate
- Radioactive seeds (usually 60-120) delivered through needles
- Seeds are spaced to give the right radiation dose
- Checking the Placement
- CT scan or X-ray to verify seed locations
- Calculations to confirm proper coverage
The whole procedure takes about 60-90 minutes. You can go home the same day.
HDR Brachytherapy Procedure
For HDR brachytherapy:
- Catheter Placement
- Under anesthesia, hollow tubes (usually 15-20) are inserted into the prostate
- Tubes are secured to prevent movement
- Treatment Planning
- CT or MRI scan done with tubes in place
- Detailed plan created based on imaging
- Radiation Delivery
- You’re moved to a shielded room
- A machine connects to the catheters
- High-dose radiation source moves through each tube
- Treatment lasts 5-20 minutes per session
- Catheter Removal
- After the last treatment, tubes are removed
- No radioactive material stays in your body
HDR may involve one to four treatments. These might happen over two days for hospital stays or several weeks for outpatients.
How Well Does It Work?
Many studies show brachytherapy is effective for treating prostate cancer.
Success Rates
For early-stage prostate cancer:
- LDR Brachytherapy: 5-year disease-free rates of 85-95% for low-risk and 70-85% for medium-risk patients.
- HDR Brachytherapy: When combined with other treatments, 5-year control rates exceed 90% for medium and high-risk patients.
A major study following 1,656 patients found that after 15 years, survival rates specific to prostate cancer were excellent: 95.6% for low-risk, 94.3% for medium-risk, and 82.5% for high-risk patients.
Comparing to Other Treatments
When compared to other options:
- Brachytherapy shows similar cancer control to surgery and external radiation for suitable patients
- Often has lower rates of urinary leakage and erectile problems than surgery
- Requires fewer sessions than standard external radiation
Dr. Michael Zelefsky from Memorial Sloan Kettering Cancer Center notes: “For men with early-stage disease, the long-term results with brachytherapy are excellent and similar to surgery, but with the benefit of being less invasive.”
Side Effects and Risks
Like all cancer treatments, brachytherapy can cause side effects. These vary in how severe they are and how long they last.
Short-Term Side Effects
Common early side effects include:
- Urinary Problems: Frequent urination, urgency, weak stream, burning
- Affects up to 90% of patients
- Usually worst at 1-3 months
- Often resolves within 6-12 months
- Discomfort Between Legs: Bruising and tenderness where needles went in
- Usually mild and goes away within days to weeks
- Rectal Irritation: Discomfort, occasional bleeding, more bowel movements
- Less common than urinary symptoms
- Usually resolves within 3-6 months
- Tiredness: Mild to moderate fatigue
- Usually resolves within 2-4 weeks
Long-Term Side Effects
Possible lasting complications include:
- Erectile Dysfunction
- Affects 30-50% of men depending on function before treatment
- Often responds to medicines like Viagra or Cialis
- Risk increases with age and other health conditions
- Urinary Issues
- Chronic urinary irritation affects 5-10% of patients
- Urethral narrowing occurs in about 5%
- Urinary leakage is rare (less than 1-2%)
- Rectal Complications
- Ongoing rectal bleeding or ulcers affect 1-5%
- Rectal fistula (abnormal connection) is extremely rare (less than 1%)
- Seed Movement (LDR only)
- Seeds may occasionally move to other body areas
- Generally harmless but monitored as a precaution
Dr. Louis Potters from Northwell Health explains: “Side effects usually relate to how close the urethra and rectum are to the prostate. Modern techniques help us minimize radiation to these areas, greatly reducing complications.”
Recovery and Aftercare
Recovery focuses on managing side effects and tracking treatment success.
Right After Treatment
After LDR brachytherapy:
- You’ll go home the same day
- Avoid heavy lifting for 2-3 days
- Take mild pain meds and anti-inflammatory drugs as needed
- Use alpha-blockers to ease urinary symptoms
- Follow radiation safety guidelines
After HDR brachytherapy:
- Go home after catheter removal
- Follow similar activity rules as LDR
- No radiation precautions needed (no radioactive material remains)
Radiation Safety (LDR Only)
With permanent seed implants, follow these precautions:
- Avoid close, lengthy contact with pregnant women and small children for 2 months
- Use a condom during sex for the first 2 months
- Strain urine for the first week to catch any passed seeds
- If you find a seed, follow instructions for proper disposal
Follow-Up Schedule
After treatment, your doctor will typically:
- Test PSA every 3-6 months for 5 years, then yearly
- Perform digital rectal exam at follow-up visits
- Check urinary and sexual function
- Do a CT scan 4-6 weeks after LDR to verify dose distribution
When to Call Your Doctor
Seek medical help if you experience:
- Cannot urinate
- Severe pain not controlled by medication
- Fever over 101°F (38.3°C)
- Significant bleeding from rectum or in urine
- Symptoms getting worse after initial improvement
New Developments and Future Directions
Prostate brachytherapy continues to improve with new technology and refined approaches.
Recent Technology Advances
- MRI-Guided Brachytherapy
- Real-time MRI during seed placement
- Better accuracy and potential for higher doses to tumor areas
- Better protection of critical structures like urethra and rectum
- Focal Brachytherapy
- Targeted treatment to just the tumor area instead of the whole prostate
- May reduce side effects while still controlling cancer
- Currently being studied in clinical trials
- Biological Optimization
- Using tumor biology and genetics in treatment planning
- Custom radiation doses based on cancer aggressiveness
- Better Imaging
- Combining MRI with ultrasound for better targeting
- PET-CT guided brachytherapy for more precise treatment
Current Clinical Trials
Several important studies are underway:
- RTOG 0924: Comparing results of high-dose radiation (including brachytherapy) with standard radiation for medium-risk prostate cancer
- PEACE2: Looking at the benefit of adding local treatments including brachytherapy to systemic therapy for cancer that has spread limited amounts
- Focal Therapy Trials: Multiple studies examining partial gland treatment with brachytherapy for localized disease
Dr. Daniel Spratt from University Hospitals Seidman Cancer Center notes: “The future of brachytherapy is personalization—matching the right treatment intensity to each patient’s specific disease while minimizing impact on quality of life.”
Combining Brachytherapy with Other Treatments
For patients with higher-risk disease, brachytherapy often works best combined with other therapies.
Common Combinations
- External Beam Radiation + Brachytherapy
- Often used for medium and high-risk disease
- External radiation treats a wider area
- Brachytherapy delivers an extra dose to the prostate itself
- Studies show better outcomes than either treatment alone for higher-risk disease
- Hormone Therapy + Brachytherapy
- May be short-term (4-6 months) or long-term (2-3 years) depending on risk
- Improves outcomes for high-risk patients
- Triple Therapy
- Combination of external radiation, brachytherapy, and hormone therapy
- Used for high-risk and very high-risk patients
- Intensive approach with excellent cancer control but more side effects
The ASCENDE-RT trial showed that adding LDR brachytherapy to external radiation significantly improved outcomes for patients with medium and high-risk prostate cancer.
Cost and Insurance
Financial aspects of brachytherapy are important considerations for many patients.
Typical Costs
Costs vary based on location, facility, and treatment approach:
- LDR brachytherapy typically costs $9,000 to $20,000
- HDR brachytherapy may cost $15,000 to $30,000
- Combined therapy with external radiation can exceed $50,000
These prices include consultation, planning, procedure, and follow-up care but may not cover additional tests or managing complications.
Insurance Coverage
Most insurance plans, including Medicare, cover brachytherapy for suitable candidates:
- Coverage usually requires proof of medical necessity
- Pre-approval is often required
- Out-of-pocket costs vary by insurance plan
- Deductibles, copays, and coinsurance apply based on specific policies
For patients with financial challenges, many hospitals offer assistance programs. Some manufacturers also provide patient assistance for radioactive sources.
Patient Experience and Quality of Life
Understanding what patients actually experience can help set realistic expectations.
What Patients Say
Research on patient-reported outcomes shows:
- Most patients are satisfied with their treatment choice
- Quality of life usually dips in the first 3-6 months but returns to normal for most patients by 12 months
- Urinary symptoms are the most common challenge early in recovery
- Sexual function changes tend to develop more gradually over 1-2 years
Richard M., age 62, who had LDR brachytherapy, shares: “The procedure itself was straightforward. The first few weeks were uncomfortable with urinary symptoms, but these improved significantly by three months. Five years later, I’m cancer-free with minimal side effects.”
What Affects Quality of Life
Several factors influence how you feel after treatment:
- Age and function before treatment
- Prostate size and urinary function before treatment
- Technical quality of the implant
- Use of additional treatments like hormone therapy
- Supportive care and side effect management
Research published in the Journal of Clinical Oncology found that men treated with brachytherapy had better urinary control but similar sexual function compared to those who had surgery, after adjusting for age and other factors.
Making Your Decision
Choosing the right treatment for prostate cancer requires careful thought about multiple factors.
Questions to Ask Your Doctor
Consider asking:
- Am I a good candidate for brachytherapy?
- What are my chances of cancer control with this treatment?
- What type of brachytherapy do you recommend and why?
- What side effects should I expect, and how long might they last?
- How many of these procedures have you done?
- What is your center’s infection rate and complication rate?
- Will I need other treatments like external radiation or hormone therapy?
- How will we check if the treatment is working?
- What other options should I consider?
- How might this treatment affect my daily life?
Team Approach
The best decisions often come from talking with multiple specialists:
- Urologist
- Radiation oncologist
- Medical oncologist
- Primary care doctor
Many major cancer centers offer clinics where you can meet with different specialists on the same day to discuss all treatment options.
Common Questions
Q: Is brachytherapy painful? A: The procedure happens under anesthesia, so you won’t feel pain during treatment. Some discomfort, bruising, and soreness in the days after are common but usually managed with mild pain medications.
Q: How soon can I return to normal activities? A: Most patients return to normal activities within a few days. Avoid heavy exercise and lifting for 1-2 weeks. You can usually resume sex within 1-2 weeks for LDR and right after catheter removal for HDR.
Q: Will the radioactive seeds trigger airport security? A: Modern airport security systems typically don’t detect the low radiation from brachytherapy seeds. However, you can ask your doctor for a wallet card documenting your implants.
Q: How does brachytherapy compare to robotic surgery? A: Both treatments show similar cancer control rates for early-stage disease. Surgery removes the prostate completely but has higher rates of immediate urinary leakage. Brachytherapy is less invasive with quicker recovery but causes more irritative urinary symptoms at first.
Q: Can I have brachytherapy if my cancer returns after surgery? A: Yes, “salvage” brachytherapy is sometimes used when cancer returns locally after surgery. Side effects may differ from those in previously untreated patients.
Q: Does brachytherapy cause other cancers? A: The risk of secondary cancers from radiation exposure is extremely low. Long-term studies haven’t shown significant increases in secondary cancer rates compared to the general population.
Conclusion
Prostate brachytherapy offers a targeted approach to treating prostate cancer. For the right patients, it provides excellent cancer control rates similar to more invasive options while often preserving quality of life.
The best prostate cancer treatment is highly personal. It depends on cancer characteristics, patient preferences, and quality of life goals. Brachytherapy continues to improve through technology advances and ongoing research.
As with any cancer treatment decision, patients benefit from thorough discussions with experienced healthcare providers. Consider all available options and weigh the potential benefits and risks based on your unique situation and values.