Prostate Brachytherapy

What is prostate brachytherapy?

Brachytherapy (also known as ‘seed implantation’) is a method of treating prostate cancer that has not spread beyond the prostate gland. Using ultrasound image guidance, radioactive seeds are placed into the prostate via needles inserted through the perineum (skin just behind the scrotum). Brachytherapy has increased in popularity over recent years due to its effectiveness and relative convenience.

Which patients are best suited for prostate seed implantation?

Prostate brachytherapy is an alternative to traditional external beam radiation or surgery for men who have early stage prostate cancer (cancer that has not spread outside the prostate gland.) Seed implantation is also an attractive option for men whose age or other health conditions preclude radical prostatectomy, or who may be unable to undergo 8 weeks of daily treatments for external beam radiation therapy.

What is involved in the procedure?

You will first meet with the doctor in consultation to discuss your treatment options. If you decide to undergo brachytherapy, you will be scheduled to undergo an ultrasound of the prostate, called a volume study. The purpose of the volume study is to take images of your prostate gland, which are then used to plan the seed placement into the prostate and estimate the number of seeds required.

After the volume study, you will be scheduled for the actual brachytherapy procedure, as well as for a pre-operative evaluation prior to the procedure.

I had an ultrasound with my biopsy, can I expect the volume study to be the same?

The two procedures are very similar except during the volume study there is no needle used, so you will not experience the pain sometimes associated with the biopsy procedure.

How long does the volume study take?

You should expect to be in our clinic for about an hour. Before the volume study, you will be given a prescription for medication to help you relax during the study. A Foley catheter will be placed into your bladder before the study. The volume study itself will take approximately 20 minutes, after which the catheter will be removed. Usually the doctor is able to inform you at that time if the volume study shows you are a good candidate for brachytherapy.

Can I drive myself home after the volume study?

Because of the medication to help you relax, you should have someone drive you home after the volume study is over.

What findings on the volume study might prevent me from having brachytherapy?

The most common situation preventing brachytherapy is when a man has a prostate gland that is significantly enlarged from benign prostatic hypertrophy. If this is the case, then you may need treatment with hormones for 2-3 months in order to decrease the size of your prostate gland, after which you will return for another volume study to ensure that the prostate has reduced by an adequate amount before proceeding with brachytherapy.

How long does the actual brachytherapy procedure take?

Approximately two to two-and-a-half hours. Afterwards you will spend an hour or two in the recovery room recuperating from the anesthesia. You will then be discharged from the hospital and given an appointment to return to the radiation oncology clinic the next day for a CT scan. The purpose of the CT scan is to double check the seed placement. You will then be asked to return for a follow up visit in one month.

Who is involved in the procedure?

You will be treated by a team of physicians including a radiation oncologist, urologist, medical physicist (physicist who specializes in the use of radioactive materials for medical purposes), and anesthesiologist.

Will I have pain after the procedure?

Most patients experience little to no discomfort upon waking up from the procedure. Although rarely used by patients, we will provide you with prescriptions for pain medication if over-the-counter remedies are not adequate.

When is external beam radiation used with brachytherapy?

For patients whose prostate cancer has a moderate chance of having spread to the area just outside the gland, external beam radiation may be combined with a slightly lower dose of brachytherapy. The purpose of the external beam radiation (link to IMRT) is to treat the area surrounding the prostate which may be involved. Usually we have patients undergo the brachytherapy first, followed by five weeks (25 treatments) of external beam radiation 2-4 weeks afterwards.

Are the seeds permanent?

Yes, although the radioactively gradually ‘decays’, the seeds are permanently in your body. The seeds are encapsulated in titanium, an inert metal commonly used in medical devices.

What precautions do I need to take around my family and friends?

Detailed, written instructions will be given to you before your implant. (link to instructions)

If you must have more prolonged or close contact with people, there also are available leaded undergarments which decrease exposure by approximately 95-97 percent.

What type of seed will I receive?

There are two types or ‘isotopes’ of seeds that are commonly used, iodine and palladium. Currently, they are generally considered to be equally effective in treating prostate cancer. The vast majority of our patients receive palladium seeds. Palladium has a half life of 17 days, meaning after every 17 day period the radiation activity has declined by half. This means that after 2 months, the radioactivity in your body is about 6% of what it initially was just after the procedure.

Are there any side effects from seed implantation?

It is normal for some blood to be seen in the urine and ejaculate for a few days or weeks after the procedure. Most patients experience some temporary increase in their frequency of urination and may have a slower stream than before, due to swelling of the prostate after the procedure. You will be given medication to help with this. These symptoms generally improve over the next several weeks. Occasionally patients may experience mild loose stools or trace blood with their bowel movements over this same time period.

Long term, the probability of retaining erectile function after brachytherapy is similar to or slightly better than with surgery or external beam radiation. There are also other, more uncommon potential side effects which your doctor will discuss with you.

Do I need to abstain from sexual activity after the procedure?

Seeds represent minimal risk to a sexual partner; however, patients should abstain from sexual activity for two weeks after the procedure, and wear a condom during sex for the first three months until the seeds have mostly decayed in activity.

Will the seeds set off alarms at the airport?

No. We have had no patients experience problems with airport travel or security devices.

How do I arrange to discuss brachytherapy with a physician?

You may obtain an appointment by calling our referral office at (410) 955-8964.

More specific information about what to expect from the procedure is available at:

Volume Study Letter
Clear Liquid Diet
Implant Instruction Letter
Post-implant Instruction Letter