Understanding Internal Radiation Therapy for Prostate Cancer

There are 2 kinds of radiation therapy for prostate cancer:

• External-beam radiation therapy (EBRT). This type uses a machine like an X-ray machine to send radiation to your prostate.
• Internal radiation therapy (brachytherapy). For this type, tiny radioactive seeds or tubes that can hold a radioactive wire are placed directly into your prostate.

For these treatments, you’ll work with a radiation oncologist. They’ll help you decide the best type of treatment for you. They’ll go over how much radiation you’ll get and how often you’ll need treatment. The rest of this article focuses on the internal type.

Treatment with brachytherapy depends on several things. These include the size of your prostate, your symptoms before treatment, and any prostate procedures you already have had done. This kind of treatment is good for prostate cancer that is growing slowly. It’s also a good choice for prostate cancer that hasn’t spread to other parts of the body.

The 2 types of brachytherapy are permanent and temporary. Both are done in a hospital. Anesthesia will be used to keep you comfortable. Your healthcare provider will talk to you about the type of anesthesia you will get. Follow your provider's instructions on how to get ready for either procedure.

• Permanent brachytherapy (low-dose rate, or seed therapy). In this type, your healthcare provider puts a thin, hollow needle in the skin between the scrotum and anus to reach your prostate. They put radioactive seeds (pellets) inside the needle. The seeds are then placed into the prostate tissue. The seeds are tiny. They’re about the size and shape of a grain of rice. The number of seeds used depends on the size of your prostate. The seeds give off low doses of radiation over several months. They stay in your body. The radiation weakens over time.
• Temporary brachytherapy (high-dose rate). During this type, your provider uses thin, hollow needles to put several soft nylon tubes into exact spots in your prostate. The tubes are connected to a machine that controls the delivery of the radiation. The provider sends a wire containing radioactive pellets through the tubes into the prostate. The wires stay in the tubes only during treatment. They are then removed after a short time, often a few minutes. This treatment may be done over several sessions. You may need to stay in the hospital during this time. Once treatment is finished, the tubes are gently removed.

Before brachytherapy, your provider might suggest you get:

• A lymph node biopsy. This test checks to see whether the cancer has spread beyond the prostate gland. Your provider will remove 1 of your lymph nodes to check it for cancer.
• Other tests. You might have an ultrasound or a CT or MRI scan. These imaging tests will help your provider figure out exactly where to place the radioactive seeds or the tubes used to hold the seeds.

After treatment, your cancer team will track your symptoms and reactions. You’ll have regular lab tests and scans, as well as follow-up appointments. During these visits, tell your provider how your recovery is going and ask any questions.

For permanent brachytherapy, the seeds will give off small amounts of radiation for at least several weeks to months. It’s unlikely these doses will harm other people. To be safe, your provider may tell you to not have close contact with pregnant people and small children for a short time. Your provider may also suggest using a condom during sex to protect others.

If you had temporary brachytherapy, no radiation stays in your body after treatment. You don't need to take safety steps after the radiation source is removed or after you go home. But you may have to limit some visitors while getting treatment in the hospital. Pregnant people or children may not be allowed to visit during your hospital stay. You may also need to keep a certain distance from other visitors or make visits short.

Radiation therapy can affect your whole body. So some side effects are likely. You may have symptoms that affect your bladder and intestines since they are near your prostate. Knowing what to expect can help you prepare.

Your side effects may include:

• Pain, bruising, or swelling in the area where the needle(s) was placed
• Severe tiredness (fatigue)
• Blood in the urine or semen for a short time after treatment
• Diarrhea or intestinal cramping
• Blood in your stool
• Pain or burning feeling in rectum
• Problems peeing (trouble starting to pee, feeling the need to go often, or a burning feeling when you pee)
• Erectile dysfunction or having problems with erections. This side effect depends on things like your age and ability to have erections before treatment. Most people have some trouble with erections after radiation therapy in the short- and long-term.

Side effects depend on the amount and type of radiation you had. Some side effects might appear during treatment or right after it. Others might happen weeks or months after the treatment. Many side effects go away over time. Remember to tell your providers about them. They can help you manage side effects.

You have a lot to think about. Your care team will help you decide whether brachytherapy is best for you.