Brachytherapy

Brachytherapy places the source of radiation within the body, inside or next to the tumour. It is also known as internal radiotherapy. This treatment aims to destroy the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. in the prostate glandAn organ with the ability to make and secrete certain fluids. from within the affected area.

Recommended if you have:

  • Localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Not had a transurethral resection of the prostate A procedure to shave away some of an enlarged prostate, which eases pressure from the prostate on the urethra, the tube that carries urine from the bladder.(TURP), which can raise your risk of incontinenceThe involuntary passage of urine or faeces. after the procedure.

It is also an option, used with external beam radiotherapy The treatment of disease using radiation.(EBRT), sometimes known as a 'brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour. boost', if you have locally advanced prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

There are two types of brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour.:

  • High dose rate
  • Low dose rate.

With both types you will need to stay overnight in hospital.

Brachytherapy is not recommended for all men, for example, men with an enlarged prostate A gland that surrounds the urethra near the bladder. It produces a fluid that forms part of the semen. (although larger prostates can be shrunk first by hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy).

High dose rate brachytherapy

This involves inserting tiny catheters or tubes into the prostate, a procedure that is done via the skin between the testicles and rectum under general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body.. A measured dose of radiation is placed inside the catheters, which are then removed after a few minutes leaving no radiation behind. This is controlled by a computer. Transrectal ultrasound (TRUS) is used to ensure that the tubes are inserted correctly.

Advantages of high dose rate brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour.

  • Higher dose of radiation delivered to the prostate glandAn organ with the ability to make and secrete certain fluids.
  • Less damage to surrounding normal tissue, such as urethra, bladderThe organ that stores urine., and rectum
  • Course of EBRT needed is shorter
  • Possibly fewer side effects than with other treatments.

Disadvantages of high dose rate brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour.

  • General anaestheticA medication that reduces sensation. needed
  • Confined to bed during therapy
  • Need to stay in hospital for a few days
  • Risk of erectile dysfunctionInability to maintain a penile erection for sexual intercourse., ejaculationThe discharge of semen from a man’s penis at the time of sexual climax. problems, urethral stricture, incontinenceThe involuntary passage of urine or faeces., fistulaAn abnormal channel between a hollow organ and either another hollow organ, or the outside of the body. and bowel problems.

Low dose rate brachytherapy

In low dose rate brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour., small radioactive metal pellets ('seeds') are placed directly inside the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. in the prostate. The seeds are very small and you cannot feel them.

The seeds give off a low dose of radiation over several weeks or months. They are left in place permanently. These seeds hardly ever travel out of the prostate, and contain such low doses of radiation that they will not pose a problem if they do move.

The seeds are placed while you are under general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body. or have had an epiduralOn or over the dura mater, the outermost of the three membranes covering the brain and spinal cord. The epidural space is used for anaesthetising spinal nerve roots, for example during pregnancy., in which the lower body is numbed by an anaestheticA medication that reduces sensation. injection into the spine so that you can remain awake during the operation. You will be asked to lie back and place your feet in stirrups.

Transrectal ultrasound (TRUS) is used to ensure that the seeds are inserted correctly, so the doctor will first place the probe into your rectum. The doctor will insert needles through the skin between the prostate and the rectum and around 80 to 100 seeds will be inserted into the prostate.

Low dose rate brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour. works best in men with small prostates who have localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. that is small and slow-growing.

The radiation does not travel far, so healthy tissue is not as affected as during external radiotherapy. Radioactive matter will remain inside you, although in such a small dose that there is no need to worry. It is safe to have close contact or sex with your partner. Some doctors do advise, however, that you do not spend too much time with children or pregnant women for the first two months after treatment.

Advantages of low dose rate brachytherapy

  • Treatment takes only one or two days
  • You can resume your normal activities soon after treatment
  • You may not have to have hormonal therapy
  • As the radiation is targeted within the prostate, cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells are exposed to a high dose of radiation but damage to the urethra, bladderThe organ that stores urine. and rectum is minimised
  • Suitable for men who have bowel problems such as inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. (IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.).

Disadvantages of low dose rate brachytherapy

Brachytherapy may cause problems that may be short-term or may last much longer, such as:

  • Problems passing urine
  • Problems with the bowel
  • Problems getting an erectionThe enlarged, rigid state of the penis during sexual arousal.
  • Proctitis (inflammationThe body’s response to injury. of the anusThe external opening of the back passage, the rectum. or rectum)
  • Narrowing of the bladderThe organ that stores urine. neck (stricture).