Prostate Cancer and Brachytherapy: An Old Treatment Revisited

Brachytherapy is a form of treatment for localized prostate cancer that involves injecting radioactive “seeds” in and around the prostate. The seeds release radiation over a period of a few months to a year, killing the cancer cells and leaving the healthy cells intact.

Brachytherapy was first performed in the 1970s at Sloan-Kettering and a few other hospitals specializing in cancer treatments. The early procedures required a large abdominal incision and did not make use of ultrasound to ensure correct placement of the radioactive seeds. For these reasons, clinical outcomes were poor, and brachytherapy for prostate cancer patients had all but been abandoned by the 1980s. Today, thanks to the development of new insertion techniques and the use of ultrasound to help position the radioactive seeds correctly, brachytherapy for prostate cancer patients is making a comeback. Recent clinical studies have proven modern brachytherapy to be as effective a treatment for prostate cancer as surgery or external radiation. Brachytherapy also carries fewer risks than surgery or external radiation.

Brachytherapy is not useful for metastatic prostate cancer (i.e., cancer that has spread beyond the prostate to other parts of the body), but for localized prostate cancer, it is a good treatment option. Brachytherapy is an outpatient procedure performed under general or spinal anesthesia. The radioactive seeds are delivered by long, thin needles inserted into the perineum (the area between the penis and the anus). A rectal ultrasound probe helps guide the exact placement of the seeds in and around the prostate. Most men are able to resume their regular activities within seventy-two hours of the procedure.

Prostate Cancer and Brachytherapy: Safety Issues, Side Effects, and Benefits

For the most part, brachytherapy does not present any kind of environmental hazard. The patient and any secretions from his body are not considered radioactive. Some doctors, however, advise their patients to avoid sexual intercourse or to use condoms for at least two weeks following the procedure. This is because during the first two weeks after brachytherapy a few radioactive seeds may be dislodged from the prostate and expelled from the body through urination or ejaculation. Doctors also caution men who have undergone this procedure to stay at least six feet away from pregnant women or small children for the first eight weeks.

The radioactivity fades within two to six months, depending on the type of radiation used. It is considered completely gone from the body one year after treatment. Side effects may include a little blood in the urine (rarely), a mild burning sensation in the scrotum or perineum, urinary urgency or frequent urination, and pain with urination.

Brachytherapy for prostate cancer is considered as effective as major surgery or external radiation. Unlike surgery, it does not require a long hospital stay or a significant period of time away from work or other activities. Overall, brachytherapy also carries fewer risks than surgery or external radiation. If you or a loved one has been diagnosed with localized prostate cancer, ask your doctor if brachytherapy is right for you.