When is this procedure indicated?
Brachytherapy is a technique indicated for patients with organ-confined disease, PSA ≤ 10 ng/mL, Gleason histologic score 6 on biopsy, and a small prostate size.
How is it performed?
Radiation is generated by small metal rods, about the size of a grain of rice, called "seeds". The seeds are inserted inside the prosata using special needles inserted at the level of the perineal area (area between the anal orifice and the scrotum). The procedure is performed under spinal (or general) anesthesia and ultrasound guidance. Several seeds are implanted to ensure uniform treatment of the entire prostate.
Patients should be able to return to normal activities in a few days. It is best to avoid lifting weights for a few days after seed insertion. In addition, implants remain inside the prostate for life, without causing a danger to other people, because the radiation is absorbed only by the prostate tissue surrounding the seeds, and especially because the activity of the seeds decays over time. However, brachytherapy patients are advised to avoid picking up small children and to stay away from pregnant women the first few days after implantation.
Immediately after the brachytherapy procedure, a patient may have pain or bruising located around the perineum (the area between the scrotum and the anus where the needles are inserted to deliver the brachytherapy), blood in the urine and/or semen, and urinary urgency. These short-term side effects are usually mild in nature and usually resolve within the first few weeks following treatment.
In contrast to external radiotherapy, patients treated with brachytherapy suffer much less irritation of the rectum, although episodes of recto-urethral fistulas have rarely been described.