The procedure for permanent (with seeds) and temporary brachytherapy varies depending on the treatment.

During brachytherapy (permanent seed implant)

Your medical team will explain the exact procedure planned for you. Feel free to ask them any questions.

• An antibiotic will be given to you via infusion before the procedure.
• The procedure lasts from 1 hour to 1 hour 30 minutes.
• It is mostly done under local anesthesia. The lower part of your body is “frozen,” but you are not asleep. However, some patients may need to be asleep. Once you are anesthetized, a urinary catheter is placed.
• To visualize the prostate well and properly implant the radioactive seeds, an ultrasound probe is used. It is a small tube inserted through the rectum that provides clear images of the prostate, urethra, and rectum, acquiring images on the computer. The goal is to optimize irradiation to treat the tumor while sparing neighboring healthy organs.
• Ultrasound guides the insertion of needles for introducing the radioactive sources. These needles, containing the seeds, allow them to be inserted into the prostate. The needles are inserted through the perineum (the area between the testicles and the anus). The seeds (between 40 and 60) are placed with very high precision.
• No incisions are made. When the needles are removed, the skin closes immediately, similar to a blood draw.
• At the end of the implantation, you are taken to the recovery room.
• Usually, the urinary catheter is removed before you leave the hospital. If not, it is typically done the next day at a local community health center (CLSC). Normally, you leave the hospital in the evening.

During high-dose rate brachytherapy (temporary)

Your medical team will explain the exact procedure planned for you. Feel free to ask them any questions.

• The procedure lasts about 2 hours.
• The procedure is performed by an experienced radiation oncologist.
• This treatment is administered while you are “asleep” (general anesthesia or epidural). This ensures you feel no pain during the treatment, and you remain still, which is crucial. A sedative may be offered before anesthesia.
• A urinary catheter is inserted. It is a tube that goes through the penis and allows you to urinate.
• The doctor inserts small empty plastic tubes (12 to 18 catheters or more) into the skin, between the scrotum and the anus. These tubes are then inserted deeper into the body, up to the prostate, using a probe. At this stage, no radioactive source is added. The procedure takes about 45 minutes.
• The medical team ensures that these tubes are well placed and conducts a computer simulation to ensure complete treatment of the prostate and all targeted tissues. Such simulation’s main advantage is dose optimization. This method aims to administer homogeneous treatment to the prostate and reduce effects on normal structures (such as the urethra, rectum, and bladder).
• The tubes are connected to a treatment device. This device sends a radioactive source (Iridium 192) through the tubes. The treatment lasts 20 to 30 minutes.
• Then, the tubes are removed, and you are taken to the recovery room.
• Usually, the urinary catheter is removed before you leave the hospital. If not, it is typically done the next day at a local community health center (CLSC). Normally, you leave the hospital in the evening.

Your return home and instructions to follow are similar to those described for external beam radiotherapy.