Brachytherapy

Brachytherapy is a form of internal radiation. Small radioactive seeds are permanently implanted into the prostate through needles inserted into the gland. Doctors use a machine which is placed in the rectum and bounces sound waves off the prostate. This creates an image of the prostate gland on a computer screen. While watching the screen, the doctor inserts needles into the prostate going through the skin behind the testicles. The sound waves bounce off the needles and the doctor can tell precisely where the needles have been placed.

About one month before your implant, you will have an examination with the ultrasound machine to measure your prostate and allow your doctor to determine how many seeds are needed for your implant. On the day of the procedure, you will be given an anesthetic and the implant will be done. It takes about an hour to implant the seeds and patients generally do not have to be admitted to the hospital. After you awaken from the anesthetic, you can go home.

Here at Saint Joseph’s Cancer Center in Tampa, Florida we use the Interplant by CMS inc. for seed implantation. This is the only system available in which the ultrasound probe and the treatment planning computer are connected to each other. Not only does this allow doctors to see—in real time—where they are putting the needles, but if adjustments in the needle placement are necessary, your doctor will be able to tell immediately how the adjustment will affect the quality of the implant. This is important because the seeds cannot be moved once they are implanted. Needle position is critical.

An X-ray of the pelvis showing
the cluster of radioactive seeds in the prostate gland.

Other systems require the physician to “preplan” your implant in the clinic, and then try to reproduce it in the operating room. It can never be as precise as our real time system.

Once the needles are in place, radioactive seeds smaller than a grain of rice are injected into the prostate through the needles. Depending upon the type of cancer the patient has, the seeds may be made of Iodine 125, or Palladium 103.

Complications are usually mild although most patients do have some urinary frequency for about three months after the implant. Tell your physician if you experience this as medicines are available to treat it. Bleeding and bruising are common and usually mild pain is uncommon and you should call your doctor if you are having pain. Long term side effects can occur due to exposure of normal pelvic tissues to the radiation. Your doctor will explain all of these effects to you in detail.

The radioactive seeds remain in your body for the rest of your life and gradually become less radioactive. Your doctors will follow you for many years after the implant procedure with regular rectal examinations and PSA blood tests. Long term cure rates for cancer of the prostate using seed implants appear very similar to the cure rates using surgery. And it sure is easier on you!