Advantages of brachytherapy

• Quick recovery, so most men can return to their normal activities shortly after treatment.
• No hospitalization required: it’s a one-day procedure.
• Radiation does not pass through the skin or other healthy organs to reach cancer cells. Brachytherapy therefore causes less damage to neighboring organs.
• Less demanding treatment than traditional radiotherapy and less taxing than radical prostatectomy.
• No recovery period or operative stress, as with radical prostatectomy.

Disadvantages of brachytherapy

• You will generally need to have general anesthesia, which can have side effects.
• The exact nature and extent of your tumor cannot be known as precisely as after surgery.
• Failures can only rarely be treated surgically (the exception). Radiotherapy may have damaged the prostate and surrounding tissues, making prostate removal more difficult and increasing the risk of side effects.
• You will experience a significant decrease in ejaculate and loss of fertility if you want children.
• You will need to avoid sitting very close to pregnant women or children for more than a few minutes each day, for the first three months after treatment.

Risks and complications of brachytherapy

Some adverse effects may occur immediately after the procedure or a few weeks later. Generally, they are temporary, may last a few months, and gradually disappear within the year following the end of treatment.

Short-Medium term

The side effects of brachytherapy are similar to those of external beam radiotherapy but differ slightly. As the prostate has been punctured multiple times, this treatment causes it to swell. This can cause urinary problems, with symptoms such as:

• Frequent urination, especially at night.
• Urgent need to urinate (urgency).
• Difficulty urinating with a weaker stream.
• Burning sensation when urinating.
• Sometimes even complete urinary blockage (acute urinary retention).

Pain in the perineum, presence of blood in the urine or semen, and transient erection problems may occur following treatment.

Irritation of the intestines and rectal disorders, such as inflammation of the rectum, are uncommon. However, diarrhea, anal irritation, or rectal bleeding may occur in the months following treatment, although very rare.

Long term

Late effects may occur months or even years after this treatment. Side effects vary and may include:

• Erectile dysfunction.
• The risks of urinary incontinence or symptoms of chronic urinary obstruction are rare (in both cases, less than 5%).

These effects depend greatly on your condition before the intervention. A person who already had good erections OR few urinary problems is less at risk of consequences.

It is important to report any side effects to your doctor.

Whether short-medium or long term, most can be relieved by taking medication or other interventions/methods.

Before the start of treatment

Shortly before beginning your treatment, you will meet with your medical team to prepare for and commence your treatment.

A few weeks before treatment

You may receive a call to schedule an appointment at a pre-admission clinic. There, you will undergo various tests to complete your health assessment.

The day before treatment

You must not eat or drink anything after midnight. If you need to take medication, you can have a small amount of water. You will need to perform a rectal enema, as instructed.

On the day of treatment

Inform the doctor of all medications you usually take. Bring them in their original containers. You will be given an antibiotic by infusion before the procedure.

Bring to the hospital a not-too-tight pair of underwear that you feel comfortable in, and an absorbent pad. You will be more comfortable when you return home.

The process of these interventions

The process of permanent brachytherapy (with seeds) and temporary brachytherapy differs depending on the treatment. To learn more about the process of these interventions, click here .

Convalescence following brachytherapy

High dose-rate brachytherapy: Your return home and instructions to follow are similar to those described for external radiotherapy treatment. Low dose-rate brachytherapy requires only a short recovery period.

To learn more about discomforts after your treatment, safety measures, and resumption of sexual activities, click here.

Medical follow-up

Medical certificate

If you need a medical certificate, remember to request it directly from your radiation oncologist.

Success rate

As with radical prostatectomy, it is impossible to establish a general success rate with brachytherapy.

• This varies depending on each case because the diagnosed grade of the tumor, its stage of spread, and the PSA level before treatment must be taken into account.
• The lower these data are, the better the chances that the patient will be definitively cured.

PSA test

Rectal examination and prostate-specific antigen (PSA) test, performed regularly – every three to six months – allow your radiation oncologist to monitor your condition. The PSA test is the best predictor of prostate cancer recurrence.

Your PSA level

With brachytherapy, it is not expected that the PSA level will drop to 0 ng/mL since normal prostate cells still remain. Usually, the PSA level drops to a plateau and remains there. Your level should start to decrease in the months following the start of treatment. It may even continue to decrease one year after treatment.

At each follow-up appointment, your radiation oncologist will evaluate three parameters:

• if the PSA level increases
• how long after treatment it occurred
• and how long it takes for this level to double (this is its velocity)

Recurrence

If the PSA level starts to rise, the doctor will monitor how long it takes to double. The shorter these periods, the greater the risk of recurrence, and the more aggressive the recurrence will be. For example, a PSA level that starts to rise eight months after the end of treatment and doubles in six months is much more concerning than a PSA level that starts to climb three years after this intervention and takes one year to double.

If necessary, hormone therapy may be prescribed. Otherwise, discuss with your radiation oncologist the options for salvage treatments after brachytherapy.

Remission

You will be followed up for at least five years after your radiotherapy. After seven to ten years without recurrence, the risks of the cancer returning are then low.

Side effects

The side effects of brachytherapy depend on the following factors:

• the type of implants (temporary or permanent)
• the volume of the treated area
• the dose of radiation that may have reached neighboring organs, usually very low
• the total dose received

Some side effects occur immediately after the intervention or a few weeks later. Generally, they are temporary. Others appear well after the intervention and can last a long time. The most common problems associated with brachytherapy are urinary, gastrointestinal, and erectile function issues.

Intestinal and urinary function

Sometimes intestinal and urinary functions take longer to return to normal at the end of treatment.

• Some medications – such as suppositories or cortisone enemas that help reduce rectal inflammation – and muscle relaxants that can sometimes provide relief – may be prescribed.
• Request an appointment with a nutritionist or dietitian for your intestinal problems.
• Discuss your urinary problems with your doctor. Often, they can be easily corrected with medication or intervention.

To learn more about urinary and intestinal disorders, see our section on side effects.

Erectile function

The percentage risk of erectile dysfunction can vary from patient to patient. However, unlike other side effects, erectile dysfunction gradually appears several months or even years after treatment, but does not affect enjoyment.

• Since cell death is progressive, you will retain your erectile capacity for several years, but it will decrease over time.
• Your erectile capacity depends on your sexual function before treatment, your age, and your overall health.

To learn more about erectile dysfunction, see our section on sexual disorders.