13 October 2022
When it comes to making the right decision about your treatment, understanding your options is important. This articles explains brachytherapy and will help you figure out whether it might be suitable for you.
If you have any questions or would like to find out more, give a PCFA Specialist Nurse a call on 1800 22 00 99.
What is Brachytherapy:
Brachytherapy is a type of radiation therapy in which a sealed radioactive source is placed directly into or next to an organ or tissue with a cancer in it. There are two main types of brachytherapy – low dose rate (LDR) or a high dose rate (HDR). ‘Dose rate’ refers to the speed at which the dose is delivered, not the actual dose itself.
The type of brachytherapy can vary but it may include small seeds, needles, pellets or similar to be inserted into your body.
Brachytherapy may not be available in all hospitals and is not suitable for all prostate cancers.
Who is suitable:
Your suitability for prostate brachytherapy is often dependent on the stage of your prostate cancer, Gleason grading and PSA, prostate size and amount of cancer present within the prostate, your current urinary symptoms and ability to tolerate an anaesthetic.
Low-dose rate brachytherapy:
Low dose rate brachytherapy (LDR-BT) is a treatment for men with localised disease. When the cancer is found only in the prostate gland. It is generally used in treating cancer in men who meet the following criteria:
- Disease stage - localised prostate cancer
- Gleason score equal to or less than 7
- Initial PSA level lower than 10ng/ml
- Less than 50% of biopsy cores involved with cancer
- A prostate volume of less than 50cm3
- Minimal urinary symptoms
- No previous prostate surgery.
LDR brachytherapy involves the permanent insertion of up to 100 sources (often called seeds) through the perineum into the prostate, delivering a dose of radiation to a small area around each seed over a number of months. The ‘seeds’ aim to destroy the cancer cells in the prostate. Placement of these ‘seeds’ requires a procedure under anaesthetic that typically takes a couple of hours.
The low levels of radiation in the seeds generally aren't harmful to others, but as a precaution, you may be asked to avoid close contact with children and pregnant women for a short time. Your doctor may advise you to wear a condom during sex.
Temporary high-dose Rate Brachytherapy
High dose rate brachytherapy (HDR-BT) is generally a treatment for men with locally advanced disease and/or when the cancer has higher Gleason scores and/or volume. It is generally used to treat cancer in men who meet the following criteria:
- Men with locally advanced prostate cancer - disease stage T3
- Lower stage cancers with high Gleason scores and/or high tumour volume.
HDR-BT involves the delivery of radiation over a short time period (approximately 10 minutes) after an anaesthetic to temporarily insert thin flexible tubes through the perineum into the prostate through which the radioactive source material is delivered. This may be repeated on several occasions over a few days, prior to removal of the flexible tubes. HDR-BT is often given in conjunction with external beam radiation therapy (EBRT) for locally advanced disease either before, or a few weeks after, and in some cases with hormone therapy.
Side effects of brachytherapy:
Both forms of brachytherapy may impact in the short and long term. They may also cause initial pain, bruising and bleeding around the insertion site. Initially, you may experience changes in your urinary flow including an urgent sensation to pass urine, a need to void more frequently particularly at night, find it harder to pass urine, and experience a burning discomfort or blood in the urine. These generally settle but, in some cases, can return in the longer term. Sometimes these symptoms may be managed effectively with medications but in some cases, men may require surgery to manage these problems.
Men may also notice changes in ejaculation with initial blood stains, then overtime a reduced volume of ejaculate. Changes in ability to get or maintain an erection may occur with either treatment. The extent of the impact depends on a number of factors such as a man’s pre-treatment function, extent of cancer and treatments delivered.
If you notice changes in your function, reach out to your treating doctors to discuss what management options are available.
For some men, neither type of brachytherapy is suitable. Often there are effective alternate options for treatment that may be equally suitable – discuss your own circumstances with your treating doctor or give our Prostate Cancer Specialist Nurses a call on 1800 22 00 99.
Additional resources
PCFA Resources – Understanding Radiation Therapy
PCFA Educational Video - Brachytherapy for Prostate Cancer
Facing the Tiger: A survivorship guide for men with prostate cancer and their partners, Prof Suzanne Chambers AO.
Your Guide to Prostate Cancer: The disease, treatment options and outcomes – A/Prof Prem Rashid. Order your copy here.
Healthy Male: Information and factsheets on men’s health related issues: www.healthymale.org.au
