Brachytherapy for Prostate Cancer
An effective treatment for localised prostate cancer with a cure rate of around 90% after 10 years.
Dr. José Santos Dias explains the innovative minimally invasive technique for effective treatment of prostate cancer.
What is Brachytherapy?
Prostate brachytherapy is one of the most effective oncological therapies to treat prostate cancer and can be used in 80–90% of cases of localised tumours.
Compared to other treatments, it has various benefits:
- High rate of success;
- Fast operation – taking between 1 and 2 hours;
- Discharge on the same or following day;
- Few side effects;
- Rapid return to normal daily activities.
First, it destroys the cancerous cells without damaging the organs and tissues near the prostate. Second, it removes two dreaded consequences associated with prostate treatment: urinary incontinence and erectile dysfunction.
Unlike external radiotherapy, the source of radiation is precise and localised (inside the prostate).
Benefits of Brachytherapy
Interstitial prostate brachytherapy has countless advantages over other types of treatment, such as:
High effectiveness (equal to or better than external radiotherapy)
Fewer side effects (such as incontinence or erectile problems)
Less time under anaesthetic and in hospital (discharge on the same or next day)
Shorter time with a catheter (just a few hours).
Rapid return to normal day-to-day activities
However, this treatment has several practical limitations.
Normally, it is indicated for less voluminous prostates. However, with development of the technique, it is possible to perform this treatment even if the volume is over 50cc. Today, it is possible to treat slightly larger prostates. And even if the volume is very large, and the patient agrees, there is a solution: hormonal treatment prior to brachytherapy. The aim is to reduce the volume and make the technique viable.
The doctor may also feel that combining the approaches is beneficial. Brachytherapy may be associated with external radiotherapy to enhance the results.
How is the Brachytherapy Procedure Performed?
Interstitial brachytherapy, as it is also known, consists of inserting radioactive (“seed”) implants – the size of a rice grain – inside the prostate.
Controlling the number and position of the seeds is done via a highly sophisticated computerised system and specific software.
Radiation inside the seeds is gradually released without causing damage to the surrounding organs. The tiny implants remain in the prostate, i.e., they are not removed, but they become inactive after a few months.
The procedure lasts 1–2 hours (depending on the tumour) and involves anaesthetic. The patient sleeps throughout the operation or, alternatively, spinal anaesthetic is used (similar to epidural anaesthetic). The patient is awake, but no pain is felt in the lower part of the body.
Normally, prior intestinal cleansing is advised.
After the operation, a short period of hospitalisation follows, usually less than 24 hours, after which the patient can return home and to their daily activities.
This cancer treatment can be combined with other treatments to enhance the results.
Brachytherapy requires a multidisciplinary team that includes a urologist, radiotherapist, physicist and anaesthetist. Working together, the approach can achieve successful results.
This is a relatively non-invasive technique. Unlike traditional surgery, there is no need for a surgical incision.
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What is the Follow-Up Care for Brachytherapy?
Though prostate brachytherapy has fewer side effects than other treatments, a temporary rise in urinary symptoms may occur, amongst which:
- Increased frequency of urinating (day and/or night);
- A thin or weak jet;
- Burning sensation or pain when urinating.
These are acute manifestations that tend to disappear over time, above all when patients comply with the specialist’s indications. If the symptoms persist, additional treatment may be used.
However, patients must be aware of some symptoms – for example urine with a lot of blood or clots and urinary retention, i.e., the inability to urinate or suggestion of infection. These are rare symptoms but may require short-term medical care.
Three weeks to a month after surgery, a usual routine consultation is held.
After that, consultations every 3 months in the first year are usual. After this period, if the clinical situation allows, the period is usually extended (every 4 months in the second year, then every 6 months and, finally, annually after the 5th year).
Follow-up includes PSA testing and a DRE, though other exams may be indicated depending on the findings or particularities of each patient detected by the urologist.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Brachytherapy
What are the benefits of brachytherapy?
How is brachytherapy performed?
Who is this technique intended for and why?
Does brachytherapy have any side effects?
- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- DIAS, José Santos. Tudo o que sempre quis saber sobre a Próstata. Lisboa: Lidel - Edições Técnicas, Lda, 2014.
- Getting Internal Radiation Therapy (Brachytherapy) https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/internal-radiation-therapy-brachytherapy.html
- What is brachytherapy? https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/brachytherapy
- What is brachytherapy for prostate cancer? https://www.webmd.com/prostate-cancer/qa/what-is-brachytherapy-for-prostate-cancer
- Brachytherapy treatment for prostate cancer (permanent seed brachytherapy) - https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Brachy%20treatment.pdf