Prostate Brachytherapy
Low Dose Rate (LDR) brachytherapy with Palladium-103 seeds delivers millimeter-level precision radiation directly to your prostate — an outpatient procedure with minimal side effects and excellent long-term cancer control.
One-time outpatient procedure. 30-60 minutes. Same-day discharge. Educational content only.
What Is Brachytherapy for Prostate Cancer?
Brachytherapy involves the insertion of tiny radioactive seeds, each about the size of a sesame seed, directly into the prostate gland. The seeds are LDR (Low Dose Rate) and contain a radioactive isotope called Palladium-103.
Once implanted in the prostate, the seeds emit a continuous low radiation dose over several weeks, targeting cancer cells while minimizing damage to healthy tissue. Eventually, the seeds stop delivering radiation. They remain in the prostate for life.
LDR Prostate Brachytherapy is an established treatment option with long-term cancer control reported in several studies. When done with intraoperative real-time adaptive planning, LDR Brachytherapy can deliver millimeter-level precision to sculpt the radiation dose to your specific anatomy and "dose-escalate" to areas of concern while minimizing radiation to surrounding healthy tissues.
Procedure and Recovery
Brachytherapy for prostate cancer is a one-time outpatient procedure. The procedure typically takes between 30 and 60 minutes.
The vast majority of men return to their normal lives the day after the procedure with minimal to no pain or discomfort.
Minimal Side Effects
Compared to many other conventional treatments for prostate cancer, modern, intraoperatively planned LDR brachytherapy has lower rates of sexual, urinary, and gastrointestinal side effects.
The precision of real-time planning allows us to maximize radiation dose to cancer while sparing the urethra, rectum, and neurovascular bundles responsible for erectile function.
Am I a Candidate?
Brachytherapy is ideal for men with early-stage prostate cancer that is less likely to spread beyond the prostate. It may also be combined with other treatments for men with intermediate or high-risk prostate cancers or those who have a greater chance of their cancer spreading beyond the prostate.
Final recommendations depend on your:
- PSA level and trajectory
- Biopsy results (Gleason score, number of positive cores)
- Imaging (MRI to assess extracapsular extension)
- Prostate size (ideal range 20-60 grams)
- Urinary symptoms (IPSS score)
- Overall health and treatment preferences
The Prostate and Prostate Cancer
The prostate is a gland in the male reproductive system, about the size of a walnut. It is located below the bladder in front of the rectum, and surrounding the urethra.
Prostate cancer is the most commonly diagnosed cancer in men in the United States. One in eight men will be diagnosed with prostate cancer in their lifetime, but the earlier it is detected, the more options for treatment and the higher the chance of survival.
How the Procedure Works
Before the Procedure
- Pre-treatment imaging (CT, ultrasound, sometimes MRI) to plan seed placement.
- Urine culture to ensure no infection.
- Bowel prep the night before (mild laxative).
- NPO (nothing by mouth) after midnight.
- Stop blood thinners 5-7 days prior if directed.
- Arrive at surgery center 2 hours before scheduled time.
During the Procedure
- General or spinal anesthesia for comfort.
- Transrectal ultrasound visualizes prostate in real-time.
- Specialized software plans optimal seed distribution based on your unique anatomy.
- Needles inserted through perineum (skin between scrotum and anus).
- Palladium-103 seeds deployed through needles into planned locations.
- Real-time dosimetry adjusts plan during procedure for maximum precision.
- Typically 40-100 seeds placed depending on prostate size.
- Foley catheter placed temporarily.
- Total time: 30-60 minutes.
Recovery and Aftercare
Immediate Recovery
- Discharge home same day after brief observation.
- Catheter usually removed before you leave (sometimes next day at office visit).
- Minimal to no pain — managed with ibuprofen or acetaminophen.
- Blood-tinged urine or semen for 1-2 weeks is normal.
- Avoid heavy lifting (>20 lbs) for 1 week.
- Return to work in 1-3 days for most patients.
Long-Term Follow-Up
- PSA monitoring every 3-6 months.
- PSA typically rises initially (radiation effect), then declines over 1-2 years.
- Post-implant CT at 1 month to verify seed placement and dosimetry.
- Annual follow-up for at least 10 years.
- Seeds remain in prostate permanently but stop emitting radiation after ~1 year.
Radiation Safety
Palladium-103 has a short half-life (17 days), meaning radiation dose decreases rapidly. After 1 year, seeds are essentially inert.
Precautions (first 2 months):
- Avoid prolonged close contact with pregnant women or young children (maintain 6-foot distance for extended periods).
- No restrictions on daily activities, work, or casual interactions.
- Use condom during intercourse (rare seed passage, but precautionary).
- Carry wallet card with implant information for airport security or medical procedures.
Clinical Outcomes
Evidence: Decades of published data support LDR brachytherapy as an effective, well-tolerated treatment for localized prostate cancer. Intraoperative real-time planning further improves outcomes by optimizing seed placement during the procedure.
Comprehensive Prostate Cancer Care Close to Home
In collaboration with Western Radiation Oncology, Advanced Urology provides a team of skilled physicians specializing in urology and radiation oncology for prostate cancer patients. The team is committed to offering the latest and most advanced treatment options. Their patient-centered approach means treatment is tailored to each patient's individual needs.
Meet the Doctors
Steven Kurtzman, M.D.
Director of Western Radiation Oncology
Dr. Kurtzman is a board-certified radiation oncologist in practice since 1996. He is nationally renowned for his real-time prostate brachytherapy expertise. He has taught the brachytherapy technique to physicians across the U.S. for two decades and has served on medical advisory boards for multiple companies regarding brachytherapy.
Ankit Agarwal, M.D.
Director of Prostate Brachytherapy
Dr. Agarwal has treated over 1,000 men using intraoperatively planned prostate brachytherapy at centers across the United States. In addition, he has treated several hundred men with Cyberknife/SBRT radiation therapy, intensity modulated radiation therapy, and radiopharmaceutical treatments such as Xofigo and Pluvicto. He has published in leading national academic journals and has served in leadership roles in the AMA and ASTRO.
John Shumway, M.D.
Director of Advanced Prostate Cancer Therapeutics
Dr. Shumway is a skilled radiation oncologist who specializes in brachytherapy for prostate cancer. He is the lead radiation oncologist at one of the busiest brachytherapy programs on the West Coast (El Camino Hospital) and leads the advanced prostate cancer division of Western Radiation Oncology, focusing on treatments such as Pluvicto. Dr. Shumway routinely travels across the country to perform prostate brachytherapy.
Brachytherapy vs. Other Treatments
- vs. Radical Prostatectomy: Brachytherapy is outpatient, no incisions, lower rates of incontinence/ED. Surgery offers definitive pathology and immediate cancer removal.
- vs. External Beam Radiation (EBRT): Brachytherapy is one-time procedure (vs. 20-40 daily treatments). Both effective; brachytherapy may have fewer bowel side effects.
- vs. Active Surveillance: Brachytherapy treats cancer definitively while preserving function. Active surveillance monitors without treatment.
- vs. Focal Therapies (HIFU, Cryo, Laser): Brachytherapy treats whole gland but with precision dose sculpting. Focal therapies treat lesion only but require ongoing surveillance.
Potential Side Effects
Urinary
- Increased frequency/urgency during first 3-6 months (usually resolves).
- Burning with urination (temporary, managed with medications).
- Urinary retention requiring catheter (<5%).
- Long-term incontinence (rare, <2%).
Sexual & Other
- Erectile dysfunction develops gradually in 20-40% over 2-5 years (lower than surgery).
- Rectal discomfort or urgency (rare, <5%).
- Blood in urine or semen (temporary).
- Seed migration (extremely rare; seeds designed to stay in place).
Care Coordination
If your provider has determined you are a good candidate for Brachytherapy for Prostate Cancer Treatment, you will receive a call from our care coordination partners at Western Radiation Oncology (a California-based company) with more information.
Please Note: The call will come from 650-960-7397.
Western Radiation Oncology provides patient education videos, FAQs, and comprehensive information about the brachytherapy process.
Frequently Asked Questions
Will the seeds set off metal detectors?
Rarely. The seeds are titanium-coated and very small. Carry your implant card for security screenings. Most patients pass through without issue.
How long does radiation last?
Palladium-103 has a 17-day half-life. Most radiation is delivered in first 3 months. After 1 year, seeds are essentially inert but remain in place permanently.
Can I have an MRI after brachytherapy?
Yes. Modern brachytherapy seeds are MRI-compatible. Inform the MRI technologist about your implant.
What if my cancer comes back?
Salvage options include salvage prostatectomy, salvage cryotherapy, HIFU, or systemic therapy. PSA monitoring detects recurrence early.
How soon can I return to work?
Most patients return to work within 1-3 days. Avoid heavy lifting for 1 week. Sexual activity can resume after 2 weeks.
Is brachytherapy as effective as surgery?
Yes. For early-stage prostate cancer, brachytherapy has equivalent long-term cancer control to surgery (85-95% at 10-15 years) with fewer side effects.
Next Steps
If you've been diagnosed with localized prostate cancer and want a highly effective treatment with minimal disruption to your life, brachytherapy may be an excellent option. Our prostate cancer team will review your case and coordinate with Western Radiation Oncology to create a personalized treatment plan.