Temporary brachytherapy (pronounced brack-ee-therapy) is when radioactive pellets are put into your prostate gland. They release radiation to destroy nearby cancer cells. Your doctor takes them out at the end of the treatment and once they've been taken out you're not radioactive.
With brachytherapy, your doctor puts the radioactive source as close to the cancer as possible. So that the cancer gets a high dose but nearby tissues and further away the levels of radiation are low.
When you have high dose rate brachytherapy
You may have high dose rate brachytherapy alone or with hormone therapy and external beam radiotherapy for cancer that hasn't spread outside of the prostate (localised prostate cancer).
You meet members of your treatment team. You sign the consent form to agree to the treatment and can ask questions. It helps to write down all your questions beforehand to take with you. The more you know about what is going to happen, the more confident you will feel.
The radiotherapy team
A member of the radiotherapy team tells you about:
- the treatment you're going to have
- the benefits
- the possible risks
- what to expect afterwards
The anaesthetist gives you the anaesthetic and looks after you during the treatment. They make sure you’re fit enough to have it.
The nurse specialist
The nurse checks your:
- general health
- blood pressure
You might also have a heart tracing (ECG).
You need to tell the treatment team if you are taking any medicines. If you are taking blood thinning drugs you might need to stop taking them up to 2 weeks before having the radiotherapy.
You might start taking a medicine called tamsulosin. It helps you to pass urine. And your doctor might give you antibiotics. They will tell you how long you need to take these medicines for.
You stop eating from 4 to 6 hours before the treatment if you're having anaesthetic. But you can drink water until 2 hours beforehand.
The treatment day
You might go into the hospital ward on the morning of the treatment or you might go the evening before. Your nurse will give you elastic stockings to wear to reduce the risk of blood clots.
You might need to empty your bowels and bladder. To empty your bowels you might have an enema. An enema is a liquid that you put into your back passage or you may be given a liquid medicine, called a laxative to swallow.
A member of the treatment team takes you to the operating theatre. A nurse or anaesthetist puts a small tube called a cannula into a vein in the back of your hand. You might have a medicine into the cannula to make you feel sleepy. And your anaesthetist might put a thin tube into your back to give a spinal anaesthetic so that you feel nothing below the waist. Or you might have a general anaesthetic so that you are asleep.
Preparing for treatment
Your doctor puts a thin tube called a catheter into your penis. The catheter shows the position of the urethra within the prostate gland on ultrasound. It also drains urine from the bladder during the procedure.
Your doctor puts an ultrasound probe into your back passage (rectum). It gives a clear picture of your prostate on a screen. Using needles, the doctor puts between 15 to 35 small tubes into your prostate through the area of skin between the scrotum and anus (the perineum).
Once the tubes are in place the doctor takes out the ultrasound probe. You then go to the recovery room, where you will wake from the anaesthetic. You will then be collected for your planning scan.
The CT scan shows the exact size and position of the cancer in the prostate gland. It also shows the position of the tubes. It takes about 15 minutes. You might also have an MRI scan that takes about 15 minutes.
You lie on the scanner couch with the treatment area exposed.
Once you are in position the radiographers move the couch up and through the scanner. You need to lie very still. Your radiographers leave the room and the scan starts. It takes about 5 minutes. You won't feel anything. The radiographers watch from the room next door.
After the scan
You go back to the ward for about 2 hours. During this time the radiotherapy team works out exactly how much radiotherapy you need.
You need to stay as still as possible so that the tubes in the prostate don’t move. You might have support pads under your legs and bottom. Your legs will be numb if you are having a spinal anaesthetic.
If you feel any soreness or pain, tell your doctor or nurse. They can give you painkillers and keep you as comfortable as possible.
You might have another CT scan.
You will be taken to the treatment room. The radiographers attach the brachytherapy machine to the tubes in your prostate. The radiographers leave the room but they are nearby and can see you on a CCTV screen. You can speak to them if you need anything.
This part of the treatment takes between 15 to 40 minutes. You need to stay very still.
The computer controlled radiotherapy machine passes small radioactive metal pellets through the tubes. This gives the precise dose of radiotherapy that you need.
When the treatment has finished the radioactive pellets go back into the machine. Your radiographers gently take out the tubes. This can be painful but you can have painkillers and gas and air if you need it.
You are taken back to your ward. You usually still have a catheter to drain your urine but your nurse takes it out after a few hours or the following day.
You stay in hospital overnight and go home the next day. You might need to stay in longer if you have problems passing urine.
You have some swelling and bruising between your legs for a few days. Your nurse will give you painkillers. Warm baths can also help. Avoid strenuous activity for a week or so.
You might have a burning feeling when you pass urine and will have blood in the urine for the first few hours. You may have traces of blood for the next few weeks. You might also need to pass urine more often than usual. Don’t have sex for the first 1 or 2 weeks if you have stinging or burning when passing urine.
If you have to wait before urine starts to flow, it can help to put your penis into a bowl of warm water. Your doctor might also advise you to take a higher dose of tamsulosin.
Drinking a small glass of water every hour can help to flush out the bladder. It also reduces the chance of blood clots. Avoid or cut down on drinks that might irritate the bladder, such as fizzy drinks and alcohol. Also limit caffeinated drinks like tea, coffee and cola.
Some men find they can’t pass urine at all. This is called urine retention. If your tummy (abdomen) feels swollen and uncomfortable but you can’t pass urine, go to your local accident and emergency department. The staff there will put in a catheter to drain your bladder. You might need to have this in for a few weeks. Up to 1 in 10 men (10%) have this after high dose brachytherapy
You might feel tired for the first few days after treatment as you recover from the anaesthetic. Rest when you need to.
You might notice blood in your semen for a few weeks after the treatment. Ejaculation can also be painful at first but tends to settle in time. After a while you may notice that you have very little or no semen due to the radiotherapy.
You may have constipation, loose poo or diarrhoea for a few weeks due to inflammation of the bowel. Tell your doctor or nurse if you have it. They can give you medicines.
Rare side effects
High dose rate brachytherapy is generally a very safe procedure. But a very few people have
- bladder damage
- bowel damage
- injury to the muscle that controls poo
- an opening that forms between the urethra and bowel
These are very unlikely to happen to you.
You are not radioactive
All the radioactive material is removed after treatment. So you can do all your normal activities.
You have an outpatient appointment about 6 weeks after the treatment. If you go on to have external radiotherapy you start that within a few weeks of the HDR treatment. You have regular blood tests to check the level of a protein called prostate specific antigen (PSA) in your blood.