Side Effects

This treatment is much better tolerated than most men would think. Surprisingly perhaps, there is only a minor amount of discomfort associated with the treatment catheters and we are very careful to give adequate pain relief to make sure that patients remain as comfortable as possible.  Usually, patients say the most uncomfortable part of the procedure is “having to lie flat on their back” for the duration of the treatment.

The prostate is relatively insensitive to pain.  Most of the discomfort associated with the procedure is caused by the treatment catheters in the skin or the template between the legs.

Short Term Side Effects

  • Nausea, caused by the anaesthetic or drugs used for pain relief.
  • Constipation and bowel gas, which is a result of the special diet to prevent bowel movement for the duration of the implant.  This may go on for a week following the implant and can also result in stomach discomfort.
  • Urinary difficulty, as patients have a catheter placed during the procedure and this can sometimes cause some problems.  Sometimes they may feel as if they want to pass urine, even with the catheter in place.  Painful contractions of the bladder known as “bladder spasm” occur rarely.  Sometimes there is some blood in the urine during the time of the procedure and immediately afterwards.

When the treatment catheters are removed, it is rare to see any significant bleeding from the area where the treatment catheters were in place.  It usually only requires a simple dressing.  There can be some bruising between the legs and in the scrotum, which often looks worse than it feels.  This will clear up over the following few days and weeks.

There might be blood in the urine for a while after the catheter is removed but this settles down quite quickly and it is not common for it to cause any obstruction of the urine flow.

Long Term Side Effects

Long term side effects are not common after HDR brachytherapy, and are certainly less of a problem than radical prostatectomy, however they are possible.

Urinary

Strictures are the narrowing of the urethra (the tube which runs from the bladder, through the prostate, in which urine flows).  Strictures are caused by scar tissue around the urethra pulling in the sides and narrowing it.  Strictures are commonly caused by trauma, associated with what Doctors call “instrumentation”.  Other causes are infections or surgery on the urethra, such as radical prostatectomy.  Radiation, from brachytherapy or external beam radiotherapy, can also cause a stricture.  In this case the stricture is almost always in the region just below the prostate, and usually occurs at least one year after the brachytherapy.

Narrowing can occur and obstruct the flow of urine before one year; however these are usually caused by swelling and will improve over a few months.  Most brachytherapy related strictures can be helped by simple stretching by a Urologic surgeon.  More serious strictures may need to be cut open with a small operation from within the urethra.  Most strictures will settle down and not require repeat procedures.

Irritable bladder

In a small number of men the radiation can make the bladder abnormally sensitive to filling, and this can result in needing to pass urine frequently and in a hurry.  There can also be associated penile discomfort.  This is also quite uncommon, and can be helped with simple medication.

Bowel

Long term bowel problems after HDR brachytherapy are very infrequent, but are possible.  These problems may increase the frequency and urgency of bowel motions, and may cause the loosening of the bowels.  Sometimes there may also be mucous or blood mixed with the bowel motion.  If this happens and persists, it is important to investigate it thoroughly to make sure there is no sinister underlying cause.

Sexual Function

Frequently men are concerned about problems with sexual function (erectile dysfunction), as a result of HDR brachytherapy.  This has been difficult to quantify exactly, particularly because the HDR brachytherapy is often given in conjunction with hormone treatment and external beam radiotherapy which could potentially cause impotence in their own right.  It is thought that in general terms, of men who are fully potent prior to treatment, 60-70% will regain and maintain this.

There may be a period after the implant and external beam radiotherapy when men are temporarily impotent.  Other changes in sexual activity include men experiencing discomfort with ejaculation for a few weeks after treatment but this will improve.  Also, it is common for the volume of the patient’s ejaculate to decrease.

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