Prostate brachytherapy

Description

Brachytherapy takes 30 minutes or more, depending on the type of therapy you have. Before the procedure, you will be given medicine so that you do not feel pain. You may receive:

• A sedative to make you drowsy and numbing medicine on your perineum. This is the area between the anus and rectum.
• Anesthesia. With spinal anesthesia, you will be drowsy but awake, and numb below the waist. With general anesthesia, you will be asleep and pain-free.

After you receive anesthesia:

• The doctor places an ultrasound probe into your rectum to view the area. The probe is like a camera connected to a video monitor in the room. A catheter (tube) may be placed in your bladder to drain urine.
• The doctor uses ultrasound or a CT scan to plan and then place the seeds that deliver radiation into your prostate. The seeds are placed with needles or special applicators through your perineum.
• Placing the seeds may hurt a little (if you are awake).

Types of brachytherapy

• Low-dose radiation brachytherapy is the most common type of treatment. The seeds stay inside your prostate and put out a small amount of radiation for several months. You go about your normal routine with the seeds in place.
• High-dose radiation brachytherapy lasts about 30 minutes. Your doctor inserts the radioactive material into the prostate. The doctor may use a computerized robot to do this. The radioactive material is removed right away after treatment.

Why the Procedure is Performed

Brachytherapy is often used for men with a small prostate cancer that is found early and is slow-growing. Brachytherapy has fewer complications and side effects than standard radiation therapy. You will also need fewer visits with the doctor.

Risks

Risks of any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks of any surgery are:

• Bleeding
• Infection

Risks of this procedure are:

• Impotence
• It may become harder to empty your bladder, and you may need to use a catheter
• Rectal urgency, or the feeling that you need to have a bowel movement right away
• Skin irritation in your rectum or bleeding from your rectum
• Other urinary problems
• Ulcers (sores) or fistula (abnormal passage) in the rectum, scarring and narrowing of the urethra (all of these are rare)

Before the Procedure

Tell your doctor or nurse what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription.

Before this procedure:

• You may need to have ultrasounds, x-rays, or CT scans to prepare for the procedure.
• Several days before the procedure, you may be told to stop taking medicines that make it hard for your blood to clot. These medicines include aspirin, ibuprofen (Advil), clopidogrel (Plavix), and warfarin (Coumadin).
• Ask your doctor which medicines you should still take on the day of the surgery.
• If you smoke, try to stop. Your doctor or nurse can help.

On the day of the procedure:

• You will likely be asked not to drink or eat anything for several hours before the procedure.
• Take the medicines your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

You may be sleepy and have mild pain and tenderness after the procedure.

After an outpatient procedure, you can go home as soon as the anesthesia wears off. In rare cases, you will need to spend 1 - 2 days in the hospital. If you stay in the hospital, your visitors will need to follow special radiation safety precautions.

If you have a permanent implant, your doctor may tell you to limit the amount of time you spend around children and women who are pregnant. After a few weeks to months, the radiation is gone and will not cause any harm. Because of this, there is no need to take out the seeds.

Outlook (Prognosis)

Most people remain cancer-free or their cancer is in good control for many years after this treatment. Urinary and rectal symptoms may last for months.

Alternative Names

Implant therapy - prostate cancer; Radioactive seed placement; Internal radiation therapy - prostate

References

D'Amico AV, Crook JM, Beard CJ, DeWeese TL, Hurwitz M, Kaplan ID. Radiation therapy for prostate cancer. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 104.

Nelson WG, Carter HB. DeWeese TL, Eisenberger MA. Prostate cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2008:chap 88.

Thompson I, Thrasher JB, Aus G. Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update. Reaffirmed 2009. Available at http://www.auanet.org/content/clinical-practice-guidelines/clinical-guidelines/main-reports/proscan07/content.pdf. Accessed December 13, 2012

Update Date: 12/12/2012

Updated by: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.