Brachytherapy for prostate cancer:
Brachytherapy is a form of internal radiotherapy where a radioactive source is placed inside the prostate to kill cancer cells.
The testicles
The testicles are two small, oval-shaped organs located below the penis, enclosed in a skin pouch called the scrotum.
Image of the testicles (cruk)
Starting from puberty, the testicles begin producing sperm. Inside the testicle, small tubes come together to form the epididymis, a single tube that becomes wider as it exits the testicle. This wider tube is known as the spermatic cord.
The spermatic cord leads to a short passage called the ejaculatory duct, which opens into the urethra, the tube that carries urine and semen out of the body through the penis.
Testosterone:
The testicles produce the hormone testosterone, which is responsible for developing male characteristics such as:- A deeper voice
- Facial hair growth
- Increased muscle mass
- The ability to achieve an erection
- Male sexual drive (libido)
Where does testicular cancer start:
The testicles consist of various cell types, and the kind of cancer you have depends on the specific cell where it begins. Most testicular cancers arise from germ cells, which are responsible for producing sperm. Doctors classify germ cell cancers into two main types:- Seminoma
- Non-seminoma
Brachytherapy for prostate cancer:
Brachytherapy is a form of internal radiotherapy where a radioactive source is placed inside the prostate to kill cancer cells.
In permanent seed brachytherapy (low dose rate), radioactive seeds are left in the prostate and release radiation slowly over several months.
In temporary brachytherapy (high dose rate), a higher dose of radiation is given, and the radioactive source stays in the prostate for about 15 to 40 minutes before being removed, leaving no radiation inside your body.
Sometimes, both internal and external radiotherapy are used. External radiotherapy involves using a machine outside the body to direct radiation beams at the cancer.
Permanent seed brachytherapy for prostate cancer:
Permanent seed brachytherapy (brack-ee-therapy) involves placing tiny radioactive metal seeds into your prostate gland. These seeds emit low-level radiation over several months to target the prostate area. It’s a type of internal radiotherapy.
In brachytherapy, the radioactive seeds are positioned very close to the cancer. This ensures the cancer receives a high dose of radiation, while the nearby tissues get much lower levels.
This treatment is also known as permanent brachytherapy or low dose rate (LDR) brachytherapy.
Depending on your specific cancer, you might receive a different form of brachytherapy called temporary brachytherapy.
When you might have permanent seed brachytherapy:
You might undergo permanent seed brachytherapy for prostate cancer that is confined to the prostate gland, known as localized prostate cancer.
During treatment:
You’ll go to the operating room for the procedure. Your anesthetist may insert a thin tube into your back to administer a spinal anesthetic, numbing you from the waist down, or you might receive a general anesthetic to put you to sleep.
Typically, your doctor will insert a thin tube called a urinary catheter into your penis, passing through the urethra, which is the tube that carries urine from your bladder. The catheter helps to identify the position of the urethra within the prostate gland via ultrasound and also drains urine from the bladder during the procedure.
An ultrasound probe will be placed in your rectum to provide a clear image of your prostate on a screen. Using this image, your doctor will insert fine needles through the skin between the scrotum and the rectum (the perineum) to place between 60 to 80 small radioactive seeds into your prostate.
Image of brachytherapy (cruk)
After treatment:
You will remain in the operating area until the effects of the sedation or anesthetic have worn off. During this time, you may wear an oxygen mask for a while. Once you’re ready, a nurse will escort you back to your ward. You may have a catheter in place to drain urine, but the nurse typically removes it after a few hours. You might also have an X-ray to ensure the seeds are correctly positioned.
You can usually go home once you can urinate normally, although you might need to stay in the hospital overnight.
Side effects of permanent seed brachytherapy:
Permanent seed brachytherapy can cause various side effects. Each person experiences these differently, and you may not have all the side effects mentioned.
Pain and Swelling
You might notice some swelling and bruising between your legs where the needles were inserted. Your nurse will provide painkillers to help manage the discomfort. Taking warm baths can also offer relief.
Urinary Issues
You might feel a burning sensation when you urinate and notice traces of blood for a few days. You could also find yourself needing to urinate more frequently or having difficulty passing urine. It’s important to drink at least 2 litres of water daily.
Reduce or avoid drinks that can irritate your bladder, such as fizzy drinks and alcohol. Also, limit caffeinated beverages like tea, coffee, and soda.
Fatigue
Feeling tired for the first few days after treatment is normal as you recover from the anesthesia. Make sure to rest when necessary.
Blood in Semen
You might observe blood in your semen for a few weeks following the treatment. Ejaculation may be painful at first, but this should improve over time. Eventually, you might notice a decrease or absence of semen due to the radiotherapy.
Bowel Problems
Constipation, loose stools, or diarrhea may occur for a few weeks because of bowel inflammation. Inform your doctor or nurse if these symptoms arise, as they can provide medication to help alleviate them.
Long-Term Side Effects
Some side effects can persist for months or even years after treatment. These include urinary leakage and difficulties with erections.
Safety precautions:
Your doctor will give you advice on precautions after your treatment. They may suggest keeping a 1-metre distance from pregnant women or children, including not having them sit on your lap. However, you can be in the same room with them for as long as you want. These precautions are usually necessary for about 2 months after the treatment.
There is a slight chance that a seed may come out when you use the toilet. If this happens, avoid touching it directly. Use tweezers, tongs, or a spoon to pick it up and flush it down the toilet. Inform your consultant about it.
You can safely have sex and share a bed with your partner after treatment. It’s recommended to use a condom during sex for a few months in case a seed comes out.
There is a small risk that a seed might move out of the prostate gland. There have been rare cases of seeds moving to the bladder or lungs. If this happens, it usually doesn’t cause any harm.
Follow up:
About 4 to 6 weeks after your treatment, you’ll have a CT scan to ensure all the seeds are correctly positioned. You will also have regular blood tests to monitor the level of prostate-specific antigen (PSA) in your blood.
Daignosis
If you have any symptoms, your first step is usually to visit your GP. They will discuss your symptoms with you and conduct an examination. Based on their findings,
Treatment options
A team of healthcare professionals (multidisciplinary team) will determine your treatment plan. Most people undergo surgery to remove the affected