Indications:

Brachytherapy is a radiation therapy technique used to treat prostate cancer. The procedure itself consists of a permanent seed implant of the prostate with usually a six week course of external beam radiotherapy. This procedure is indicated for men with prostate cancer that is not believed to have spread to other organs or bones. In general, the same patients who have traditionally been candidates for either radical prostatectomy or standard external beam radiotherapy, and other "local" treatments, are also candidates for the brachytherapy.

The risks as explained below are those risks where the patients have had their seed implant and external beam done at the same facility controlled the by the same doctor.

Risks:

Short Term Side Effects:

1. Urinary: Include frequency, urgency, increase in nighttime urination, slow stream and intermittency (stop and start) of urination. The degree of symptoms varies from man to man and is influenced by the level of both pre-existing symptoms and the size of the prostate gland in general. Most symptoms are easily controlled with medications such as Flomax, Cardura or Hytrin and sometime Ibuprofen (Advil), which help to relax the muscles that control urination. In the vast majority of cases, urinary obstruction requiring a catheter does not occur. However, this again is influenced by the level of a man's pre-treatment symptoms and the size of his prostate gland. Even in patients with normal urinary function, about 5% of men can develop urinary obstruction requiring a temporary catheter and this likelihood can rise depending upon how severe a man's symptoms are before treatment. Overall, only a very small fraction of men have prolonged urinary obstruction and less than 1% have required a TURP (Roto-Rooter operation) for chronic obstruction.

While this procedure is generally painless, some men may feel fullness in the perineum where the needles were inserted. In addition, the scrotum (bag) may temporarily turn black and blue. Blood may also be seen in the urine. Sexually active men may notice dark or rusty colored semen, and some may have a feeling of spasm at ejaculation. Although not required, some men may wish to use a condom. These side effects are normal and usually resolve quickly.

2. Rectal: These symptoms are most strongly influenced by a history of hemorrhoids. Men who have a history of hemorrhoids or rectal bleeding will typically find an increase in their symptoms during the six to seven weeks of external beam irradiation following implant. This is typically the first symptom to resolve after therapy. Most patients find these symptoms to be only bothersome and rarely require medication.

Long Term Side Effects:

1. Urinary: Patients who have not had a prior TURP have a less than 1% chance of developing chronic urine leakage. A sole exception to this would be slight leakage associated with urinary urgency during the course of treatment. This is infrequent, occurs in less than 5% of patients and typically resolves within several months. Based on this track record, it is exceedingly unlikely that a patient will develop chronic urine leakage. However, this cannot be completely excluded. Urinary bleeding is rare but may occur, especially if taking aspirin.

Men who have undergone prior TURP (Roto-Rooter operation) have a greater risk of urinary problems than men who have not. About one-third of men who have had a TURP will develop some leakage of urine, usually associated with urgency. Half of these men (one-sixth of all TURP patients) find this to be only mildly irritating and do not require a pad. The other half (one-sixth of all TURP patients) however will develop sufficient leakage to require a pad. Less than 2% of all men treated with TURP have developed urinary leakage requiring catheterization.

2. Sex Function: Overall, 72% of men with good sex function will maintain an erection sufficient for intercourse. However, some men will completely lose their erection and others may find the quality of the erection to be diminished. This risk may be made worse by chronic disease such as high blood pressure, diabetes or heart disease. Also, the ejaculate (semen) may decrease with time. Whether this results in sterility is unknown. However, if you are considering having children in the future, we strongly advise sperm banking.

3. Rectal: Chronic long-term rectal complications are rare. Looking at nearly 1,200 men, only 6% of patients have required use of suppositories after treatment for rectal symptoms. The most common symptom is a few drops of blood on the stool after a bowel movement. While we cannot be completely exclude the possibility of rectal damage requiring colostomy, this risk is estimated at substantially less than 1%. These results are based on examination of over 1,200 men treated with the ultrasound-guided technique.

4. Second Cancer: I am not aware of reports documenting an increased risk of second cancers over that of the general population as a result of radiation therapy to the prostate by seeds and EBRT. There is one study of patients having conventional radiation between 1983 and 1993 showing some increase in secondary cancers. However much has changed in the ratiation treatment since that time in which they were covering broad fields with the beam. However, men may still develop other cancers unrelated to treatment in the rectum and bladder as well as other sites. We encourage men to keep up with their family doctors for complete physicals each year.

The information presented here is not meant to be exhaustive but to cover the most common and significant potential complications encountered with one clinic. The less skilled doctors and those doctors with lesser experience will have patients suffer with higher side effects then what is reported here.