Prostate Brachytherapy: What You Should Know

Andrew Siegel MD   9/14/2019      Prostate Cancer Awareness Month

Radiation can be delivered externally—from a source outside of the body—as reviewed in last week’s entry.  Alternatively, radiation can be delivered internally, from a source within the body.  This internally-sourced radiation is known by the term “brachytherapy.”

marijana1 pixabay

Thank you Marijana1 at Pixabay for image above

Dr. GG

Dr. Glen Gejerman, Director of Radiation Oncology at New Jersey Urology


The word “brachytherapy” comes from the Greek word βραχύς brachys, meaning “short-distance” or “short,” since the radiation source is placed in close proximity to the site being treated. Brachytherapy is a minimally invasive procedure in which radioactive sources are implanted directly within the prostate gland. The two techniques are low dose rate brachytherapy and high dose rate brachytherapy.

Low dose rate brachytherapy (LDR) uses titanium-encapsulated radioactive seeds (each about the size of a grain of rice) that are implanted directly into the prostate. After the radiation is “spent,” the seeds that remain are harmless “shells.” LDR brachytherapy is largely of historical interest since it is rarely used anymore.

High dose rate brachytherapy (HDR) uses temporary flexible plastic needles (a.k.a. “after-loaded” catheters) that are placed through the perineum (anatomical area between scrotum and anus) and are used as a vehicle through which Iridium–192 wires are advanced into the prostate gland. A computer-controlled system calculates how long the “hot” wires stay in each dwell position within the needles, which determines the delivered dose. Once each treatment is finished, the radioactive wires are removed from the prostate. Three fractions of high dose rate brachytherapy are delivered over a course of a 24-hour hospital stay. HDR is typically reserved for patients with high risk prostate cancer—Gleason scores 8-10, higher tumor volume and elevated PSA.  It is most often done in conjunction with long-term androgen deprivation therapy.

Advantages of HDR brachytherapy:

  • Delivery of a high dose of radiation into prostate with minimal radiation to healthy adjacent tissues
  • Short hospitalization and rapid recovery
  • Ability to treat high risk prostate cancer

Disadvantages of HDR brachytherapy:

  • Need for anesthesia and brief hospitalization
  • Need for urinary catheter
  • Short-term discomfort and blood in the urine from plastic needles sutured into the perineal area

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health




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