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Is Brachytherapy Right for Me?

What you need to know about this common prostate cancer treatment.

Photo credit: Courtesy of Julie Shapiro

Need a cancer specialist?

Dear Doctor,

I was recently diagnosed with prostate cancer and I’m trying to figure out what to do about treatment. My doctor says I’m a good candidate for brachytherapy. But the idea of having radioactive seeds implanted in my body is freaking me out, and I’m worried about the possibility of harming people around me. Will I need to stay far away from my wife and grandchildren while I’m being treated?

Sincerely,

"Seeds of Doubt"

Dear Seeds of Doubt,

Your concerns are not uncommon. But know that brachytherapy, a type of internal radiation, is safe and effective, and the risk to family members is minimal. It has been used for decades as a treatment for many cancers, including uterine, cervical, breast, lung and brain cancers, and can even treat noncancerous conditions such as coronary artery disease.

As you have probably learned, the main ways of treating prostate cancer are with either surgery or radiation, and radiation can be done using external beam radiation, brachytherapy, or a combination of both. With brachytherapy, we insert tiny radioactive seeds into the prostate gland which give off radiation to kill the cancer. The main benefit of brachytherapy is that there is minimal radiation exposure to the parts of the body that are closest to the prostate, namely the bowel, bladder and rectum. That means patients are less likely to experience erectile dysfunction after brachytherapy than with either surgery or external radiation.

Another benefit is that the radioactive seed implantation can be completed in just a couple of hours during an outpatient procedure using minimal anesthesia. While you are asleep, we insert the radioactive seeds into the skin between your legs using very tiny needles. There are no incisions needed and generally patients have no pain. There is no need to stay overnight in the hospital.

For men like you who have low-risk prostate cancer, the cure rates from brachytherapy are the same as with either surgery or external radiation, but you have a greater chance of preserving sexual function and a better quality of life. For men who have more aggressive types of prostate cancer, combining brachytherapy with external radiation can dramatically increase cure rates.

In terms of the risk to people around you, the seeds are only radioactive for a few months, and there’s very minimal exposure for other people during that time. You can resume normal work and life activities and be around other people like you normally do—the radiation can’t spread to other parts of your body and it can’t spread to other people. However, we do tell men receiving the treatment to take precautions during those first few months, like avoid conception and do not have a pregnant woman or children sit on your lap. It’s OK to sleep in the same bed with your partner, but if you like to spoon, we ask that you put a pillow between the two of you for those first few months. After that time, the seeds are no longer radioactive—they become harmless lumps of metal that can stay in your prostate forever and don’t cause any problems.

If you’re considering brachytherapy, make sure you go someplace with a lot of expertise and a well-established program in place. You want to make sure they have the equipment, physicists and experience to guide and support you through the treatment.

Finally, I encourage you to explore all of your treatment options with both a urologist and a radiation oncologist. While brachytherapy may not be right for everybody, it can dramatically increase the cure rates in higher-risk cancers, and give men with low-risk cancers excellent cure rates and a better quality of life.

“Brachytherapy has been used for decades as a treatment for many cancers, including uterine, cervical, breast, lung and brain cancers, and can even treat noncancerous conditions such as coronary artery disease.”
Dr. Brett Cox, radiation oncologist

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Published September 11th, 2018

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