The techniques and equipment used in brachytherapy for prostate cancer have advanced and improved vastly over the last 20 years. Doctors are now able to more precisely implant the radioactive seeds. For prostate cancer patients, this means having less severe treatment symptoms and complications. The likelihood and severity of treatment symptoms varies widely. Because of the range of patient characteristics, such as age of the man and the stage of the disease, studies have shown incidences ranging from less than 1% to 70%.
What are Your Chances of Having a Prostate Cancer Brachytherapy Side Effect?
| Treatment Symptoms |
Estimated % |
| Bowel Problems |
less than 10% |
| Rectal Problems |
5-10% |
| Urinary problems/changes |
10-30% |
| Urinary Incontinence |
1-2% |
| Erectile Dysfunction |
5-30% |
| Migration of seeds |
less than 1% |
Here is what to expect from these prostate cancer brachytherapy side effects:
- Bowel or Rectal Problems (including rectal irritation)
While seed therapy for prostate cancer uses better rectal-sparing approach than external-beam radiation for prostate cancer, a small fraction of men have rectal symptoms after undergoing brachytherapy for their prostate cancer.
Some men experience loose stools, diarrhea, rectal bleeding, or rectal urgency after having prostate cancer seed implantation. Most of the time, stool softeners, steroid enemas, and anti-inflammatory drugs can help to relieve these treatment symptoms. Rectal injury is uncommon, especially if the radioactive seed implant for prostate cancer has been properly performed.
There is a rare risk of temporary bowel irritability due to the radiation, in which cancer patients have an increased frequency of bowel movements and irregular pattern of bowel activity.
Men with larger state T3 or &4 tumors who also undergo external-beam radiation, or prostate cancer patients, who require more radioactive seeds because of larger tumors, tend to experience more severe rectal problems, such as rectal ulcers. Although uncommon, more serious ulcers that are result of too much radiation on tissue in the rectum may require further attention.
Recent evidence has emerged, suggesting that hyperbaric oxygen therapy, or argon plasma coagulation, may be effective in healing rectal ulcers developed from radiation treatment for prostate cancer. This involves several sessions of sitting in a pressurized oxygen chamber.
The rectal bleeding from brachytherapy prostate cancer, in most cases, will heal over time and with the help of steroid enemas. In many cases of rectal bleeding, healing eventually occurs with time and supportive care such as steroid enemas, but if bleeding is persistent, further measure may be needed. You should consult with your doctor if you have rectal bleeding, because there may also be a possibility that the bleeding is being caused by something else, such as colorectal cancer or colonic polyps.
- Urinary problems/changes, including irritation of the urinary tract
Prostate cancer brachytherapy side effects are usually urinary. For approximately 3 months, patients feel the need to urinate more frequently. In rare cases, severe, prolonged bleeding may also occur, requiring treatment with hyperbaric oxygen.
In the past, about half of men, who’d had a transurethral resection (TUR), experienced urinary incontinence after their brachytherapy procedure. A major contributing factor of the urinary problems was the placement of the seeds. Urinary issues are more likely to develop when the radioactive seeds for the prostate cancer are implanted too close to the urethra. Such complications have become less common, as physicians have shifted to using a peripheral loading approach. However, men who have had have undergone a TUR, or another type of surgical intervention on the urethra, are increasingly being ruled out for brachytherapy.
- Urinary Incontinence
Seed therapy for prostate cancer rarely causes total urinary incontinence. The inability to empty the bladder completely is a major or immediate side effect after the procedure. Some patients experience some level of urinary retention for the first few days following seed implantation for prostate cancer. Brachytherapy treatment technology has improved considerably, so the risk of experiencing this side effect after prostate cancer seed implantation is negligible.
In such cases, the tissue surrounding the prostate cancer seed implants is reacting to the trauma of having a needle stuck in it repeatedly. Similar to the swelling of the prostate after a biopsy, the tissues react with swelling, bleeding and inflammation.
Sometimes urinary incontinence does not present itself 2 weeks to 3 months following the brachytherapy, when prostate cancer patients begin to feel the effects of their prostate cancer seed implants. The radiation causes irritation to the prostate and urethra. This, however, is temporary and typically improves and eventually goes away within a couple of months.
To avoid this prostate cancer brachytherapy side effect, some doctors will have their patients begin taking alpha blockers before the prostate cancer seed implantation procedure. Some men continue to take them for 2 or 3 months after their brachytherapy, tapering off gradually as the treatment symptoms resolve.
- Erectile dysfunction and Sexual Side Effects
Patients may experience sexual side effects after their seed implant, such as ejaculatory pain, pain the testicles, and blood in the semen. Patients can have sex about 2 weeks after undergoing seed therapy for prostate cancer. A painful orgasm may be experienced the first few times, but this is a very unusual and will go away. Blood in the ejaculate is very uncommon but can occur temporarily and may last up to 2 weeks. After a few months, it is normal for men, who had brachytherapy for their prostate cancer, to experience a dry ejaculate, or an orgasm with little, if any semen.
Doctors believe that after prostate cancer seed implantation, a man is no longer fertile, because the radiation essentially destroys the reproduction function of the prostate. For men who want to have children in the future, it is strongly recommended they bank their sperm prior starting radiation treatment for their prostate cancer.
Impotence, which is defined as having some degree of erectile dysfunction but not necessarily a complete inability to have an erection, is a major late symptom of brachytherapy. A prostate cancer patient’s ability to have an erection diminishes, reaching a plateau over time because of damage to top small blood cells. However, men who undergo brachytherapy for their prostate cancer seem to have a lower occurrence of erectile dysfunction than men who undergo external-beam radiation. For prostate cancer patients, drugs such as Viagra have been very successful in assisting with impotence, since their nerves remain intact after seed therapy for prostate cancer. As advances in technology and improvements in brachytherapy continue, experts believe that the risk for erectile dysfunction will become less common.
- Migration of seeds (outside of the prostate gland and into the urethra)
On rare occasions, the prostate cancer seed implants can migrate out of the prostate. Some doctors have patients strain their urine for 1 to 2 weeks following the seed therapy for their prostate cancer, to catch any stray seeds in the urine. Even more unusual is for radioactive seeds to enter the bloodstream and end up in one of the lungs; if this happens, it is not known to cause any ill effects.
Fortunately the migration of the radioactive seeds for prostate cancer is quite uncommon. Doctors have developed better prostate cancer seed implantation techniques, such as implanting seeds that are attached to each other, so that migration is no longer an issue.
Treatment symptoms from seed therapy for prostate cancer gradually subside over time. Because of advancing technology and a better understanding in how to better place the radioactive seeds for prostate cancer, complications and side effects are less severe for brachytherapy prostate cancer patients today.
You can usually safely return to work and resume most activities within a few days of undergoing brachytherapy. During your follow-up care, your doctor may prescribe or suggest over-the-counter medications to help control prostate cancer brachytherapy side effects. Be sure to let your doctor know if your side effects persist or become more serious.
