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Prostate Cancer

Prostate Cancer Radiation

For the treatment of prostate cancer, radiation is an alternative to surgery that is similar in effectiveness to surgery. Radiation can be given in divided doses given over 7 weeks (external beam radiation) or with a solitary treatment (brachytherapy or radiation "seeds") that release radiation slowly during that time.

​Prostate Brachytherapy

 Who is a candidate for brachytherapy?

Three criteria must be met for you to be a good candidate for brachytherapy. First, you must not have a significant problem with prostatic obstruction. To help you determine this your doctor will probably have a questionnaire for you to fill out to evaluate how much your prostate causes hesitancy, double voiding, voiding at night, etc. If the prostate obstructs too much, the temporary swelling caused by the radioactive seeds can make it difficult to empty your bladder following the procedure. Second, you must have a low grade Gleason score (6 or less) or a Gleason 7 with only a very, very small volume of cancer on biopsy. If you have a higher Gleason score, you can get brachytherapy as a sole treatment for prostate cancer. However, you can undergo brachytherapy in combination with "hormones" and external beam radiation if you have more aggressive disease. Finally, your prostate size must be bigger than 20cc’s and smaller than 60 cc’s. For prostates larger than 60cc, brachytherapy can eventually be performed, but measures must be taken first to shrink the prostate prior to treatment.

 Do I need "hormones" with brachytherapy?

No. This is another advantage of brachytherapy over external beam radiation, since "hormones" have side effects such as erectile dysfunction in a very large number of patients.

 What happens to the seeds with time?

There are titanium capsules that contain the radiation which are placed into the prostate. The radiation will be slowly emitted and eventually will be gone completely (the specific time depends on if your doctor uses palladium or iodine implants). However, the housing capsules will remain in the prostate forever. These do not cause problems with metal detectors.

 What are the side effects of brachytherapy?

Brachytherapy causes problems with erections in about 30-50% of men, but this problem is frequently not noticed until a year or two after treatment. Increased urinary frequency is common following treatment but usually declines with time. Difficulty with urination is uncommon and is easily treated with medications in most cases. Rectourethral fistula is very, very rare while some constant, long-term feeling of mild to moderate tingling/burning with urination is seen in nearly all men who undergo brachytherapy.

 Do I need to take precautions with the radiation?

Some data show that very young children or pregnant females should not spend an excessive amount of time on a patient’s lap who has had brachytherapy within the last month. Radiation oncologists usually have specific recommendations depending on the particular implants used.

 What happens if the radiation fails?

For low risk cancer there is only a 5-10% chance of failure. However, if this is the case, surgery or cryotherapy can be performed. Surgery is more difficult after radiation and problems with potency and continence are both more common. Cryotherapy is a viable option, but is relatively new and has a very small, but known risk of rectourethral fistula (or abnormal connection between the bladder and the rectum). All patients should get PSA values checked (blood work) every 6 months for the rest of their lives following radiation. Any PSA greater than 1 after the PSA has "nadired" (reached a low point) is concerning.

 How long is the procedure?

The procedure is generally an hour and a half long and is performed as an outpatient procedure (no admission to the hospital).

 When can I get back to my normal activities?

If one begins lifting heavy things too soon, the chance of blood in the stool or in the urine is more likely. Most patients don’t notice these side effects for more than a day and they are very mild. However, with lifting greater than 10 pounds, these symptoms can be more severe and more prolonged. It is our recommendation, therefore, that light-duty activity can be performed in 3-7 days following the procedure and normal activities can be resumed at 2 weeks.