Brachytherapy and side effects

Brachytherapy is a specialised form of radiation used to treat prostate cancer. Here’s what you need to know about the different types of brachytherapy, who it’s for, and what side effects you may experience.

Low dose rate (LDR) brachytherapy

LDR brachytherapy involves inserting radioactive ‘seeds’ permanently into the prostate. The seeds deliver a dose of radiation directly to the prostate while minimising dose to the bladder, urethra and rectum.

How does it work?

LDR brachytherapy may be done under a general anaesthetic, where you’ll be put into a deep sleep. Or, you might be given a spinal or epidural anaesthetic, where the lower half of your body is numbed and you’ll stay awake but won’t feel anything.

The radiation oncologist places the radioactive seeds into the prostate through the skin of the perineum (space between the anus and scrotum). The number of seeds placed depends on the size of your prostate and the activity of the seeds, but they’re so small (about the size of a rice grain) they rarely cause discomfort. You’ll also have a catheter (thin tube) inserted to help drain urine from your bladder during the treatment.

The seeds will remain in the prostate gland permanently and will slowly release radiation for a period of weeks to months (this will depend on your doctor’s plan and the type of LDR seed used). During this time men will give off a low dose of radiation.

How long does it take?

The procedure usually takes about 45 minutes. Almost all men go home a few hours after the procedure — once you’ve recovered from the anaesthesia, your catheter has been removed, and you can urinate (wee) normally.

Follow-up care

Up to 6 weeks after treatment, you may have a CT or MRI scan to check the position of the seeds. After this, you’ll have regular follow up appointments to monitor your PSA levels, making sure they are dropping which indicates successful treatment. The level may continue to drop for over 12 months. The PSA often does not completely disappear but falls to a low level.

Who’s a good candidate
for LDR brachytherapy?

LDR brachytherapy is suitable for men with localised prostate cancer, whose cancer has not spread outside the prostate. It is best used by itself (monotherapy) for men with low or favourable intermediate risk cancers and as a boost (together with external beam radiation) for higher risk cancers.

High dose rate (HDR) brachytherapy

HDR brachytherapy involves inserting a radioactive ‘seed’ into the prostate using a number of thin hollow tubes. The seed is attached to a wire which is controlled by a machine (an ‘afterloader’) which moves the seed in and out of each tube. The seed delivers a dose of radiation directly to the prostate while minimising dose to the bladder, urethra and rectum.

How does it work?

HDR brachytherapy can be done using different types of anaesthesia. You might be given a spinal or epidural anaesthetic, where you’ll stay awake during the treatment but won’t feel anything. Or, you may be given a general anaesthetic and be put into a deep sleep while the treatment takes place.

The radiation oncologist will insert thin hollow tubes (about 10 to 20) into the prostate gland. The position of the tubes are checked using a CT scan, MRI or ultrasound scan and a radiation plan is made. The tubes are then attached to the afterloader and the treatment is delivered in a short period of time (usually less than 30 minutes). The prostate then gets a highly targeted dose of radiation to try to kill the cancer cells.

The tubes will be removed once the treatment is finished. After the treatment, the HDR seed and tubes are removed so you are not radioactive after treatment. Your doctor may advise having more than one treatment, but they can give you more details. You will also have a catheter placed into your bladder to help drain your urine during treatment.

How long will I be in the hospital?

If you’re having one HDR treatment, almost all men go home a few hours after the procedure - once you’ve recovered from the anaesthesia, your catheter has been removed, and you can urinate (wee) normally. If you’re having multiple HDR treatments, you may be admitted to hospital for 1 to 2 days. Your doctor can let you know the details.

Follow-up care

You will have a follow-up appointment with your doctor or care team within a few weeks of HDR. This will be to check on how well you’re feeling, as well as monitor your PSA.
The level may continue to drop for over 12 months. The PSA often does not completely disappear but falls to a low level.

Who’s a good candidate
for HDR brachytherapy?

HDR brachytherapy is suitable for men with intermediate-risk or high-risk localised prostate cancer. HDR brachytherapy can be used:

  • by itself (monotherapy) for men with low or favourable intermediate risk cancers

  • as a boost (together with external beam radiation) for higher risk cancers

  • if the cancer has come back in the prostate and other forms of radiation therapy have been given (salvage brachytherapy)

HDR brachytherapy may also be given alongside hormone therapy.

What about
side effects?

Brachytherapy tends to be tolerated pretty well but there are some side effects:

Urinary problems

Most men will experience some urinary problems immediately after radiation therapy, which may last several months. These problems include:

  • needing to urinate (wee) often - 'urinary frequency'

  • suddenly feeling you have to wee - 'urinary urgency'

  • burning when you urinate

  • having a hard time urinating, or feeling like you need to push your wee out

  • blood in your urine

Fortunately, these symptoms tend to be short-term and by 12 months, most men will return to their urinary function before treatment. Recovery is usually faster for men getting HDR (high dose rate) brachytherapy compared to those getting LDR (low dose rate) brachytherapy.

Sexual issues

Brachytherapy may cause some changes to your sexual function, like:

  • erectile dysfunction (ED), which often develops over time after treatment is finished

  • painful ejaculation, which may be short term or long term

  • rusty-coloured semen, in the short term

Bowel issues

Some men will experience an irritated rectum (back passage) but this is usually mild. Some men also have bleeding from the back passage. These symptoms are more common when brachytherapy is given as a boost to external beam radiation. Other effects can include:

- diarrhoea

- passing gas (or farting), more than usual

- needing to go to the toilet more often

- leaking a clear, jelly-like mucus from your bottom

- a feeling that you haven’t fully emptied your bowels, and there’s more that needs to come out

Fatigue or feeling extremely tired

Fatigue experienced during radiation therapy is usually mild but can get in the way of everyday life. It will go away after treatment ends but may take several weeks. Exercising has been shown to reduce fatigue during radiation.

If you're experiencing any of these side effects, speak to your doctor or care team. They can help make sure you get the help you need.

Important notes
about brachytherapy

  • Brachytherapy is likely to make you infertile, which means you won’t be able to have children naturally. This is because the radiation may affect your sperm and continue to do so over time. However, it is still important to use contraception if your partner can become pregnant.
    Talk to your doctor or care team about options for freezing your sperm before treatment.

  • Your doctor may suggest that you use a condom during sex for some time after treatment with LDR brachytherapy. 

  • For the first 4 to 6 months after LDR brachytherapy, your doctor may advise you to reduce close contact with pregnant women or infants (like having a baby on your lap for several hours). Even though the radiation doesn’t travel far, it is best to be cautious as it could be harmful to them.

  • If an individual who has undergone LDR brachytherapy passes away within 24 months of the procedure, their body cannot be cremated. If cremation is important to you for personal or religious reasons, please speak to your doctor or care team
    about your options
    before you have the procedure .

  • Brachytherapy is often used with external beam radiation and hormone therapy.

What's next?

Now that you've read up on Brachytherapy and side effects, here are some related articles to explore as you continue to build your knowledge and understanding of this topic.
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