Low dose rate brachytherapy is a treatment option for localised prostate cancer which involves the use of radioactive seeds being placed into the prostate. Typically, 80 or more seeds of radioactive iodine-125 are placed into the prostate gland under a general anaesthetic. The procedure usually takes approximately 2 hours. Low levels of radiation are emitted by the seeds directly to the prostate. Very little radiation penetrates outside of the prostate gland. This allows the prostate to be specifically treated while minimising the effects on adjacent tissue. The procedure takes approximately 2 hours. A catheter will be placed in your bladder and an ultrasound probe will be placed in your rectum to visualise the prostate gland. Approximately 80 seeds are then inserted into the prostate under ultrasound guidance using a number of needles which are placed between the scrotum and the anus. The needles are removed and the seeds are left within the prostate gland. You will then be admitted to the ward and your catheter will be removed the following morning. A postoperative CT scan will be obtained either the next day or at 1-3 months after the procedure.
Advantages
- Avoids major surgery
- Shorter duration of treatment than external beam radiotherapy.
- Minimally invasive.
Disadvantages
- Not all patients are suitable for brachytherapy.
- Salvage treatments are limited in cases of cancer recurrence and are associated with high complication rates.
- Impotence- The risk of impotence is approximately 22% at 1 year after the implant and is approximately 50% at 5 years. Impotence then worsens by approximately 5% per year thereafter.
- Stricture (5%) - There is a small chance that scar tissue may form in the urethra. The urethra is the tube that carries urine from the bladder through the prostate and penis. It is the tube that you pass urine through in order to urinate. In these instances, the scar tissue may need to be opened with further surgery.
- Dysuria (pain with urination) and urinary urgency and frequency are experienced by most (over 70%) men at 3 months. This typically resolves over time. The risk of some ongoing urinary symptoms at 1 year may be up to 20%. At 2 years it is approximately 2.5%, at 3 years 1.25%, and 1% at 5 years.
- Retention (2-3%) - There is a risk that you may not be able to pass urine after the procedure. This is due to swelling of the prostate gland. If this occurs, you may need to learn to pass catheters (small plastic tubes) intermittently into the bladder each time you need to pass urine. You may have to do this for some months. It is also possibly that at a much later date you may require a rebore of the prostate (TURP) to help you pass urine. There is a higher risk of incontinence associated with TURP following brachytherapy.
- Approximately 1% of patients will experience a syndrome of urinary frequency, pain and reduced bladder volume in the long term.
- Rectal toxicity - Up to 5% of patients may notice increased frequency of bowel movements and blood in the bowel motion.
- Incontinence - There is a risk that you will leak urine after the procedure. This risk is approximately 2% at about 5 years
- Fistula - There is a 1% risk that you may form an abnormal connection between the bladder and the bowel, which can result in ongoing urine infections and may require further complex surgery.
- You should not father children for at least 1-2 years after the implant until all the radiation is gone.
