Brachytherapy: Precision with Purpose

1. What is Brachytherapy?

Brachytherapy is a form of internal radiation therapy used to treat cancer. Instead of delivering radiation from outside the body, small radioactive sources called seeds are placed directly into or close to the tumour.

For prostate cancer, low-dose-rate (LDR) brachytherapy involves permanently implanting tiny radioactive seeds into the prostate. The seeds deliver radiation gradually over time, targeting the prostate while helping to limit radiation exposure to surrounding tissues.

2. Conditions Treated

Brachytherapy can be used to treat several types of cancer, depending on the type, stage and individual patient circumstances.

• LDR brachytherapy is commonly used for selected prostate cancers and can also be used in certain other cancers.
• High-dose-rate (HDR) brachytherapy is also used for cancers such as cervical cancer and in other appropriate clinical situations.

For prostate cancer, suitability is determined by the treating urologist and radiation oncologist. Factors include:

• Confirmed prostate cancer following a biopsy and histology.
• PSA level and other clinical findings.
• Gleason score/Grade Group.
• The stage and extent of the cancer.
• Prostate size and urinary function.
• Whether the cancer has spread outside the prostate.

In general terms:

• Gleason 6: generally considered lower-risk disease.
• Gleason 7: intermediate-risk disease, depending on the specific Gleason pattern.
• Gleason 8–10: higher-risk disease.

Not every patient with a particular Gleason score will be suitable for LDR brachytherapy. The oncology team will assess each patient individually and recommend the most appropriate treatment.

3. Benefits of a Day-Hospital Procedure

One of the advantages of prostate brachytherapy is that, for appropriately selected patients, the procedure can often be performed as a day-case procedure.

Patients may be able to:

• Arrive at the hospital on the morning of the procedure.
• Have the procedure performed under anaesthesia.
• Recover for several hours afterwards.
• Eat and drink once fully awake.
• Be discharged once they have recovered adequately and are able to pass urine.

A specialised day-hospital environment also allows the urology, oncology, anaesthetic and theatre teams to work together in a controlled and focused setting.

4. The Procedure – What Can Patients Expect?

Before the procedure

Once prostate cancer has been diagnosed, the patient will meet with the treating team to discuss the available treatment options.

The radiation oncologist will:

• Review the biopsy, PSA and other clinical results.
• Assess the prostate and cancer characteristics.
• Discuss the expected benefits, risks and possible side effects of radiation treatment.
• Determine the appropriate radioactive seed prescription and treatment plan.
• Assist with the necessary medical-aid authorisation and oncology benefits process, where applicable.

The patient will receive specific instructions before the procedure. These may include:

• A light or fluid diet on the day before treatment.
• Bowel preparation to help obtain clear ultrasound images of the prostate.
• Fasting from the time specified by the anaesthetist, commonly from around 22:00 the night before.

During the procedure

On the day of treatment, the patient is admitted and assessed by the medical and anaesthetic teams.

Once under anaesthesia:

1. The patient is positioned carefully in the lithotomy position.
2. A urinary catheter may be inserted, and the bladder may be filled with a measured amount of sterile fluid to improve visualisation.
3. An ultrasound probe is placed in the rectum to provide detailed images of the prostate.
4. The prostate is carefully outlined and measured using ultrasound.
5. A computer-assisted treatment plan is developed to determine the optimal position and number of radioactive seeds.
6. The seeds are inserted into the prostate through fine needles under continuous ultrasound guidance.
7. The treatment team continuously monitors the seed placement and radiation dose distribution, allowing adjustments to optimise coverage of the prostate while limiting radiation to surrounding organs.
8. Once the team is satisfied with the treatment, the needles and equipment are removed.
9. Pressure may be applied to the perineal area to minimise bleeding.
10. The catheter is removed when appropriate, and the patient is transferred to the recovery area.

5. After the procedure

Once fully awake, the patient can normally eat and drink again.

Some patients experience:

• Mild soreness or bruising around the perineum.
• Mild discomfort from the needle insertion sites.
• Temporary discomfort in the hips or legs following positioning during the procedure.
• Burning or discomfort when passing urine.
• Increased urinary frequency or urgency.
• Some difficulty passing urine due to temporary swelling of the prostate.
• A small amount of blood in the urine or semen.

These symptoms are usually managed according to the treating doctor’s protocol and generally improve as the prostate inflammation settles.

Before discharge, the patient will receive:

• Medication and post-procedure instructions.
• Information regarding possible side effects.
• Radiation-safety instructions.
• Details of when to contact the medical team.
• A follow-up appointment.
• Instructions regarding regular PSA monitoring, often at approximately three-month intervals initially, according to the treating doctor’s protocol.

6. Typical Recovery

Recovery varies from patient to patient.

Some patients feel well enough to return to normal activities very quickly, while others need several days to recover.

Urinary symptoms can take longer to settle. Temporary inflammation of the prostate can put pressure on the urethra and cause difficulty or discomfort when urinating. This generally improves gradually as the inflammation decreases.

The treating doctor will provide individual guidance on returning to work, exercise and other activities. A complete return to normal activities may take several weeks in some patients.

Closing Message

A precise treatment. A focused approach. A future beyond prostate cancer.

For appropriately selected patients, prostate LDR brachytherapy offers an effective treatment option with the convenience of a day-hospital procedure. The treatment is carefully planned to deliver radiation directly to the prostate while limiting unnecessary radiation exposure to surrounding healthy tissues.

The aim is not only to treat the cancer, but also to preserve quality of life and normal function wherever possible.