About Brachytherapy
Derived from ancient Greek words for short distance (brachy) and treatment (therapy), it is sometimes called seed implantation and is an outpatient procedure used in the treatment of different kinds of cancer. Radioactive “seeds” are carefully placed inside of the cancerous tissue and positioned in a manner that will attack the cancer most efficiently. Brachytherapy has now been used for over a century. Some of the diseases now treated with brachytherapy include prostate cancer, cervical cancer, endometrial cancer, and coronary artery disease. Brachytherapy has been proven to be very effective and safe, providing a good alternative to surgical removal of the prostate, breast, and cervix, while reducing the risk of certain long-term side effects.
In the treatment of prostate cancer, the radioactive seeds are about the size of a grain of rice, and give off radiation that travels only a few millimeters to kill nearby cancer cells. With permanent implants (for example, prostate) the radioactivity of the seeds decays with time while the actual seeds permanently stay within the treatment area. There are 2 different kinds of brachytherapy: permanent, when the seeds remain inside of the body, and temporary, when the seeds are inside of the body and then removed. Diseases treated with temporary implants include many gynecologic cancers.
For more comprehensive information about brachytherapy, you can also visit www.aboutbrachytherapy.com.
About Brachytherapy Techniques and Procedures
This section of the ABS Web site will provide you with a "walk through" description of the brachytherapy techniques used for the treatment of prostate cancer. The procedures for treating other types of cancer with brachytherapy vary widely, so ask your doctor for specific information.
Before the Prostate Brachytherapy Procedure
You generally have tests before the brachytherapy procedure. These tests may include blood tests, an electrocardiogram (EKG), and chest x-rays: your doctor will determine which tests are performed. The results are used by anesthesiologists to determine what kind of anesthesia to use for the brachytherapy procedure.
A few days before your procedure, you will be given specific instructions about preparation, including diet and enemas. These instructions are very important to follow, as they will make sure that the ultrasound image of your prostate will be clear.
Either before or during your procedure, your doctor will locate your prostate and take several computer images showing the exact location and size of your cancer. These images help your doctor and practitioners to determine the number of seeds needed and their location to most effectively treat your cancer.
During the Procedure
Brachytherapy is usually an outpatient procedure, which means you most likely will not have to spend the night at the hospital or be admitted. The actual procedure takes approximately 1 hour. Most people receive spinal anesthesia, which means that you are numb from the waist down. You may also receive medication to make you feel drowsy.
An ultrasound probe is inserted into the rectum, which will show the prostate gland on a television monitor, to aid the doctor in placement of the seeds. The seeds are then implanted into the prostate through very thin needles. Depending on different variables, between 50 and 100 seeds are used. The types of seed also vary and may include Iodine-125, Palladium-103, and echnogenic Iodine-125 seeds. The needles are inserted into the skin between the scrotum and rectum and are guided to the right place to most effectively treat the cancer. At the end of the procedure, a catheter will be placed in your bladder to help you pass urine during recovery.
After the Procedure
You will be taken to a recovery room after the procedure until the anesthesia wears off, and you can feel your legs again – this usually takes a couple of hours. While you are recovering, an ice bag is placed in the treatment area to help reduce swelling. The urinary catheter is usually removed when the anesthesia wears off, but is sometimes left in overnight. As with most outpatient procedures, you can usually go home the same day.
Once you go home, you can resume your normal eating habits, have visitors, and get back to normal life. You should avoid heavy lifting and strenuous physical activity for a few days and follow the specific instructions that your doctor gives you when you are released from the hospital. Generally, patients resume their normal activities within 4 or 5 days.
Immediate Side Effects
Directly following the procedure, you can expect some soreness and swelling in the treatment area, sometimes accompanied by bruising. It is usually mild, and only lasts for a couple of days. Your doctor can prescribe pain medication if necessary.
Short-Term Side Effects
You may also experience some side effects in the first couple of days after the procedure caused by the instruments used during the procedure. These include slight bleeding or burning beneath the scrotum or blood in your urine. These side effects are normal and aren't causes for concern; however, if the bleeding becomes severe or there are large blood clots appearing in your urine, you should contact your doctor. You should always adhere to your doctor's instructions, and ask as many questions as you need to understand what has happened, and will happen to your body.
There are side effects that don't appear for a week or two after the implant that are caused by the radiation that is being emitted into your prostate from the seeds. You may experience frequent, urgent, or uncomfortable urination. These symptoms usually decrease in severity as time goes on, as the seeds lose their radioactive strength. Your doctor will instruct you to drink plenty of water to help relieve these symptoms.
Long-Term Side Effects
There is a small chance that you may become incontinent or impotent. Patients over the age of 70 are more likely to be affected in this manner. Based on earlier reports, the rates of these long-term side effects seem to be much lower with brachytherapy than with radical prostatectomy.Be sure to discuss any concerns with your doctor.
Safety of Radiation
The seeds used in prostate brachytherapy emit a low level of radiation that doesn't travel very far. It usually doesn't travel beyond the prostate. Sometimes, very small amounts of radiation can reach other people when a seed is passed while urinating, or from the tiny amount of radiation that travels through the air. Because there is such a small amount of radiation involved, it is not considered a risk to others; however, small children and pregnant women are more sensitive to the effects of radiation, so additional precautions may be recommended by your doctor after the procedure. Ask your doctor questions about what the precautions should be, or any other questions that you have about the safety of the radiation used in brachytherapy treatments.
Follow-Up
Your doctor will tell you how often you need to be seen after the brachytherapy procedure. You need to be checked for treatment progress, treatment side effects and to make sure that the cancer has not recurred. The schedule will often be more frequent during the first 5 years following treatment.
