NCCN Guidelines for Patients
: Prostate Cancer
Part 4: Overview of cancer treatments
For LDR brachytherapy, seed placement is harder if you
have a very large or small prostate, your urine flow is
blocked, or you’ve had TURP (
rostate). Moreover, your chances for side effects are
higher. If your prostate is large, you may be given ADT
before LDR brachytherapy to shrink it. After the seeds
are implanted, your doctor should measure the radiation
dose for quality assurance.
HDR brachytherapy uses seeds made of iridium-194 that
are contained inside soft catheters. The catheters are
removed after radiation has been given. This treatment
requires staying in the hospital for 1 to 2 days. HDR
brachytherapy may be given with EBRT.
Side effects of radiation therapy
Similar to surgical treatment, a common side effect of
EBRT and brachytherapy is erectile dysfunction. Unlike
surgery, erectile dysfunction may develop several years
after radiation therapy. Although not as common as
erectile dysfunction, other sexual changes may include
difficulty achieving orgasm, thicker semen, dry orgasm,
discolored semen, and a decreased sperm count. These
less common side effects often stop after a short period
Urinary problems right after EBRT may include frequent
urination, urge incontinence, a burning sensation while
urinating, and hematuria. After brachytherapy, you may
have burning with urination, urinary retention, a slow
or weak urinary stream, overflow incontinence, and
hematuria. These side effects go away. Several years
later, radiation injury to the bladder can cause urinary
incontinence, although this isn’t common for either EBRT
or brachytherapy. However, your risk after brachytherapy
is higher if you have had a TURP.
Despite the best treatment planning and delivery, your
rectum will be exposed to some radiation during EBRT or
brachytherapy. You may have rectal pain, diarrhea, blood
in the stool, and colitis. These side effects will go away
over several months. Several years later, radiation injury
to the rectum can cause rectal bleeding and irritation but
these symptoms are rare.
EBRT may cause changes in your skin. Your treated skin
will look and feel as if it has been sunburned. It will likely
become red and may also become dry and sore and feel
painful when touched. You may also feel extremely tired
despite sleep and have a loss of appetite.
Not all side effects of radiation therapy are listed here.
Please ask your treatment team for a complete list of
common and rare side effects. If a side effect bothers
you, tell your treatment team. There may be ways to help
you feel better.
Cryosurgery is used as a salvage treatment after
radiation therapy. It is not recommended as a primary
treatment. More research is needed to compare
cryosurgery to either prostatectomy or radiation therapy.
Cryosurgery treats prostate tumors by freezing them.
Very thin needles will be inserted through your perineum