Brachytherapy for Prostate Cancer

What is Brachytherapy for Prostate Cancer

Brachytherapy for prostate cancer is radiation treatment that is placed inside of the prostate (prostate gland). There are several types of brachytherapy:

  • Low-dose rate (LDR) therapy. This may involve temporary implants or permanent radioactive seed or pellet implants. The radiation does not travel far from the prostate, which means that healthy, noncancerous tissues around the prostate receive only a small dose of radiation. This helps to protect those tissues from injury. This type of treatment may be followed by a course of external beam radiation.
    • Temporary low-dose implants are left in the prostate for 1–7 days. The implants are needles, applicators, or thin, plastic tubes (catheters) that contain radioactive material. You will need to stay in the hospital while the implant is in place.
    • Permanent low-dose implants (seeds or pellets) are injected into the prostate, and they work for up to one year after they are inserted. They are left in place and are not removed.
  • High-dose rate (HDR) therapy. This is given through needles, applicators, or catheters that contain radioactive material. The tubes are removed after treatment, and no radiation is left in the prostate. This type of treatment may be followed by a course of external beam radiation.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any surgeries you have had.
  • Any blood disorders you have.
  • Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Inflammation of the rectum.
  • Problems getting or keeping an erection (erectile dysfunction).
  • Trouble urinating.
  • Diarrhea.
  • Bleeding.
  • Loss of bowel control.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.

General instructions

  • Plan to have someone take you home from the hospital or clinic.
  • If you will be going home right after the procedure, plan to have someone with you for 24 hours.
  • You may have imaging tests done, including an ultrasound, CT scan, or MRI.
  • You may have blood tests done.
  • You may have a test to check the electrical signals in your heart (electrocardiogram).
  • You may need to take medicine to clean out your bowel (bowel prep).

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • You may have a thin, plastic tube (catheter) inserted to drain your bladder.
  • If you are receiving brachytherapy with implants:
    • A needle, applicator, or catheter will be inserted into the prostate. It will be inserted through a body cavity, such as the rectum, or through the tissue between the testicles and the anus (perineum).
    • An X-ray, ultrasound, MRI, or CT scan will be used to guide the catheter or applicator toward the prostate.
    • Radioactive seeds, wires, or ribbons will be fed through the catheter or applicator.
    • If the high-dose method is used:
      • The radioactive wires or ribbons will be left in for a few minutes and then removed.
      • Once the treatment is finished, the catheter or applicator will be removed.
    • If the low-dose method is used, the implant will stay in place for 1–7 days.
      • You will remain in the hospital while the implant is in place.
      • Once the treatment is finished, the radioactive material and catheter will be removed.
  • If you are receiving permanent, low-dose brachytherapy:
    • Small, radioactive seeds or pellets will be injected into your prostate. This may be done through a catheter, needle, or applicator.
    • The catheter or applicator will be removed, leaving the seeds in the prostate.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • Do notdrive for 24 hours if you were given a sedative.

Summary

  • Brachytherapy for prostate cancer is radiation treatment placed inside of the prostate (prostate gland).
  • There are several types of brachytherapy for prostate cancer, including low-dose temporary treatment, low-dose permanent treatment, and high-dose temporary treatment.
  • Temporary low-dose implants are left in the prostate for 1–7 days.
  • Permanent low-dose implants are injected into the prostate and left in place. They work for up to one year after they are inserted.
  • Permanent high-dose therapy is given through tubes that contain radioactive material. The tubes are removed after treatment, and no radiation is left in the prostate.

Brachytherapy for Prostate Cancer, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

  • Trouble passing urine.
  • Blood in the urine or semen.
  • Constipation.
  • Frequent feeling of an urgent need to urinate.
  • Bruising, swelling, and tenderness of the area behind the scrotum (perineum).
  • Bloating and gas.
  • Fatigue.
  • Burning or pain in the rectum.
  • Problems getting or keeping an erection (erectile dysfunction).
  • Nausea.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • If directed, apply ice to the affected area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Try not to sit directly on the area behind the scrotum. A soft cushion can help with discomfort.

Activity

  • Do notdrive for 24 hours if you were given a medicine to help you relax (sedative).
  • Do notdrive or use heavy machinery while taking prescription pain medicine.
  • Rest as told by your health care provider.
  • Most people can return to normal activities a few days or weeks after the procedure. Ask your health care provider what activities are safe for you.

Eating and drinking

  • Drink enough fluid to keep your urine clear or pale yellow.
  • Eat a healthy, balanced diet. This includes lean proteins, whole grains, and plenty of fruits and vegetables.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important. You may still need additional treatment.
  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Shower and wash the area behind the scrotum gently.
  • Do not have sex for one week after the treatment, or until your health care provider approves.
  • If you have permanent, low-dose brachytherapy implants:
    • Limit close contact with children and pregnant women for 2 months or as told by your health care provider. This is important because of the radiation that is still active in the prostate.
    • You may set off radioactive sensors, such as airport screenings. Ask your health care provider for a document that explains your treatment.
    • You may be instructed to use a condom during sex for the first 2 months after low-dose brachytherapy.

Contact a health care provider if:

  • You have a fever or chills.
  • You do not have a bowel movement for 3–4 days after the procedure.
  • You have diarrhea for 3–4 days after the procedure.
  • You develop any new symptoms, such as problems with urinating or erectile dysfunction.
  • You have abdomen (abdominal) pain.
  • You have more blood in your urine.

Get help right away if:

  • You cannot urinate.
  • There is excessive bleeding from your rectum.
  • You have unusual drainage coming from your rectum.
  • You have severe pain in the treated area that does not go away with pain medicine.
  • You have severe nausea or vomiting.

Summary

  • If you have permanent, low-dose brachytherapy implants, limit close contact with children and pregnant women for 2 months or as told by your health care provider. This is important because of the radiation that is still active in the prostate.
  • Talk with your health care provider about your risk of brachytherapy side effects, such as erectile dysfunction or urinary problems. Your health care provider will be able to recommend possible treatment options.
  • Keep all follow-up visits as told by your health care provider. This is important. You may need additional treatment.
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