Prostate Brachytherapy: A Targeted Approach to Prostate Cancer Treatment in India

Prostate cancer is a significant health concern globally, and India is seeing a rising incidence of this disease. For men diagnosed with localized or early-stage prostate cancer, choosing the right treatment path is crucial. While various options exist, prostate brachytherapy stands out as a highly targeted and effective internal radiation therapy. This advanced technique offers a precise way to combat cancer cells while minimizing impact on surrounding healthy tissues, making it an increasingly preferred choice for many Indian patients.

In this comprehensive guide, we delve into prostate brachytherapy, exploring its purpose, detailed procedure, potential outcomes, and the associated costs in India. Our aim is to provide clarity and empower you with knowledge about this innovative treatment.

What is Prostate Brachytherapy?

Prostate brachytherapy, often referred to as internal radiation therapy or seed implantation, is a sophisticated form of radiation treatment specifically designed for prostate cancer. The term "brachytherapy" originates from Greek, meaning "short-distance therapy," which perfectly describes its core principle: radioactive sources are placed directly into or very close to the cancerous tumor within the prostate gland.

Unlike external beam radiation therapy (EBRT), which delivers radiation from a machine outside the body, brachytherapy offers unparalleled precision. This direct placement ensures that a very high dose of radiation is delivered precisely to the prostate tumor, maximizing its cancer-killing effect. Simultaneously, the radiation exposure to adjacent healthy organs, such as the bladder and rectum, is significantly minimized. This targeted approach is a cornerstone of modern oncology, aiming to achieve excellent cancer control rates while preserving the patient's quality of life. For Indian patients, especially those with localized or low-to-intermediate-risk disease, brachytherapy represents a cutting-edge and often preferred treatment modality.

Why is Prostate Brachytherapy Performed?

The primary purpose of prostate brachytherapy is to eradicate prostate cancer cells by delivering a concentrated dose of radiation directly to the tumor. This precision not only enhances treatment efficacy but also plays a vital role in preventing serious complications and reducing the risk of secondary tumors, as healthy tissues are largely spared from radiation exposure.

Brachytherapy is frequently chosen for a multitude of compelling reasons:

• Exceptional Efficacy and Targeted Treatment: By placing radioactive sources directly within the prostate, brachytherapy ensures that the highest possible dose of radiation reaches the cancer cells. This localized delivery is extremely effective in destroying tumor cells while sharply limiting radiation exposure to critical surrounding organs like the bladder, rectum, and urethra. This precision is key to achieving excellent local control of the cancer.
• Minimizing Side Effects and Complications: Compared to traditional external beam radiation therapy or radical prostatectomy (surgical removal of the prostate), brachytherapy is often associated with a reduced incidence and severity of long-term side effects. The concentrated radiation reduces the risk of radiation-induced damage to nearby healthy tissues, leading to fewer urinary, bowel, and sexual complications. This directly contributes to a better post-treatment quality of life for patients.
• Convenience and Reduced Treatment Duration: Depending on the type of brachytherapy, the treatment can be significantly more convenient for patients. Low-Dose Rate (LDR) brachytherapy involves a single procedure, with the implanted seeds continuously working over several months. High-Dose Rate (HDR) brachytherapy, while involving multiple sessions, typically completes treatment within a few days or weeks, a much shorter timeframe than the several weeks required for daily external beam radiation therapy. This convenience is a significant advantage, particularly for patients with demanding schedules or those traveling for treatment.
• Preservation of Quality of Life: A major objective of modern prostate cancer treatment is to cure the cancer while preserving the patient's quality of life. Brachytherapy is particularly adept at this, as its targeted nature helps maintain urinary, bowel, and sexual functions to a greater extent than some other aggressive treatments. This focus on preserving normal bodily functions is a strong argument for choosing brachytherapy for suitable candidates.
• Suitable Candidates: Prostate brachytherapy is an excellent option for a specific profile of patients. Ideal candidates typically include:
  • Men diagnosed with localized prostate cancer, meaning the cancer has not spread beyond the prostate gland.
  • Those with low-to-intermediate-risk disease, based on factors like PSA levels, Gleason score, and clinical stage.
  • Individuals with a life expectancy of five or more years, ensuring they can benefit from the long-term cancer control offered by the treatment.
  • Patients without severe pre-existing urinary symptoms or significant prostate enlargement (benign prostatic hyperplasia), as these conditions could be exacerbated by radiation.

Ultimately, the decision to undergo prostate brachytherapy is made in consultation with a multidisciplinary healthcare team, including a urologist, radiation oncologist, and medical physicist, after a thorough evaluation of the patient's cancer characteristics, overall health, and personal preferences.

Preparation for Prostate Brachytherapy

Undergoing prostate brachytherapy involves a meticulous preparation phase to ensure the treatment is as effective and safe as possible. For Indian patients considering this procedure, a comprehensive evaluation by a dedicated healthcare team is standard.

The preparation typically includes several key steps:

• Thorough Medical Evaluation:

  • Physical Examination: A complete physical exam, including a digital rectal exam (DRE), will be conducted to assess the prostate's size, shape, and any abnormalities.
  • Medical History Review: Your doctor will take a detailed medical history, including any pre-existing conditions, medications you are currently taking, allergies, and previous surgeries. This is crucial for identifying any factors that might influence the treatment plan or anesthesia.
  • Laboratory Tests: Various blood tests will be performed, including a Prostate-Specific Antigen (PSA) test to establish a baseline, complete blood count (CBC), kidney and liver function tests, and coagulation profiles to ensure you are fit for the procedure. A urine analysis may also be done to rule out any urinary tract infections.
  • Urinary Flow Studies: To assess your current urinary function, studies like uroflowmetry may be performed. This helps the medical team understand your baseline urinary health and anticipate any potential post-treatment changes.

• Advanced Imaging and Treatment Planning:

  • Transrectal Ultrasound (TRUS): This imaging technique is fundamental. A small ultrasound probe is inserted into the rectum to obtain clear images of the prostate, measure its precise dimensions, and help in the initial planning of radioactive source placement. It provides real-time guidance during the procedure itself.
  • CT Scans and MRI: Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) are vital for precisely locating the tumor within the prostate and mapping its relationship to surrounding structures like the bladder, rectum, and urethra. These advanced imaging studies create detailed 3D models of the prostate, which are then used by the radiation oncologist and medical physicist to meticulously plan the exact placement and dosage of the radioactive sources. This "dosimetry planning" ensures that the radiation is delivered with maximum accuracy to the tumor while minimizing exposure to healthy tissues.
  • Prostate Biopsy Review: The pathology slides from your initial prostate biopsy will be reviewed to confirm the cancer's grade (Gleason score) and characteristics, which are critical for determining the most appropriate brachytherapy approach.

• Pre-Procedure Instructions and Patient Education:

  • Bowel Preparation: Patients will typically receive instructions for bowel preparation. This usually involves taking an enema or a mild laxative the day before the procedure to ensure the rectum is clear. A clear rectum allows for better visualization of the prostate during the procedure and reduces the risk of bowel-related complications.
  • Fasting: You will be instructed to fast for a specific period (usually 6-8 hours) before the procedure, meaning no food or drink, to prepare for anesthesia.
  • Medication Adjustments: Your doctor will review your current medications. If you are taking blood thinners (e.g., aspirin, warfarin, clopidogrel), you may be advised to stop them a few days before the procedure to reduce the risk of bleeding.
  • Anesthesia Consultation: You will meet with an anesthesiologist to discuss the type of anesthesia that will be used (usually general or spinal anesthesia) and to address any concerns you may have.
  • Patient Education: The healthcare team will thoroughly explain the procedure, potential risks, expected outcomes, and post-procedure care. This is an opportunity for you to ask any questions and ensure you are fully informed and comfortable with the treatment plan.
  • Support System: Patients are often advised to arrange for someone to accompany them to the hospital and assist them during the initial recovery period at home.

This comprehensive preparation phase is crucial for optimizing the success of prostate brachytherapy, ensuring patient safety, and achieving the best possible oncological outcomes.

The Prostate Brachytherapy Procedure

Prostate brachytherapy is a specialized procedure performed in a controlled environment, typically an operating room, under anesthesia. There are two primary types, each with its distinct methodology: Low-Dose Rate (LDR) and High-Dose Rate (HDR) brachytherapy.

Low-Dose Rate (LDR) Brachytherapy: Permanent Seed Implantation

LDR brachytherapy involves the permanent implantation of tiny radioactive seeds into the prostate gland. These seeds continuously emit low doses of radiation over several weeks to months, gradually destroying cancer cells.

• The Seeds: These are minuscule radioactive sources, roughly the size of a grain of rice. The most common isotopes used are iodine-125 (I-125) or palladium-103 (Pd-103). The choice of isotope depends on the specific characteristics of the cancer and the patient. I-125 has a longer half-life (about 60 days) and emits radiation over several months, while Pd-103 has a shorter half-life (about 17 days) and delivers its radiation dose more rapidly.
• Anesthesia: The procedure is typically performed under general anesthesia, ensuring you are completely unconscious and feel no pain. In some cases, spinal anesthesia may be used, numbing the lower half of your body.
• Procedure Steps:
  1. Positioning: You will be positioned on your back with your legs raised and supported, similar to a lithotomy position.
  2. Transrectal Ultrasound (TRUS) Guidance: A sterile ultrasound probe is inserted into the rectum. This provides real-time, high-resolution images of the prostate, allowing the medical team to precisely visualize the gland and guide the seed placement.
  3. Needle Insertion: Using the TRUS guidance, a series of long, thin, hollow needles are inserted through the perineum (the area between the scrotum and anus) and advanced into the prostate gland. The exact number and placement of these needles are determined by the pre-operative treatment plan.
  4. Seed Implantation: Once the needles are in the correct position, approximately 80 to 100 radioactive seeds are individually deposited into specific locations within the prostate through these needles. The seeds are strategically distributed throughout the gland to ensure uniform radiation coverage of the tumor while avoiding critical structures.
  5. Needle Removal: After all seeds are placed, the needles are carefully withdrawn. There are no incisions, only tiny puncture marks on the perineum, which usually heal quickly.
  6. Post-Procedure Imaging: Immediately after the procedure, imaging (such as a CT scan) may be performed to confirm the exact placement of the seeds and verify that the radiation dose will be delivered as planned.
• Recovery and Discharge: After the procedure, you will be monitored in a recovery area as the anesthesia wears off. Most patients can go home the same day or the following morning. You may experience some mild pain, swelling, or bruising in the perineal area, which can be managed with over-the-counter pain medication and ice packs.
• Radiation Precautions: For LDR brachytherapy, the seeds remain permanently in your body. While the radiation emitted is very localized and diminishes over time, you may be advised to take some temporary precautions, such as avoiding prolonged close contact with pregnant women and young children for a few weeks or months. Your medical team will provide specific guidelines.

High-Dose Rate (HDR) Brachytherapy: Temporary Implants

HDR brachytherapy involves the temporary insertion of a highly radioactive source into the prostate for short durations during multiple treatment sessions. This method allows for a more intense dose delivery over a shorter period.

• The Radioactive Source: The most commonly used isotope for HDR brachytherapy is iridium-192 (Ir-192), which emits a high dose of radiation.
• Anesthesia: Similar to LDR, HDR brachytherapy is performed under general or spinal anesthesia.
• Procedure Steps (Catheter/Tube Placement):
  1. Positioning and Guidance: You will be positioned similarly to LDR brachytherapy, with TRUS guidance used to visualize the prostate.
  2. Catheter Insertion: Thin, hollow plastic tubes or catheters (typically 15-20 of them) are precisely inserted through the perineum into the prostate gland, following a pre-planned pattern. These catheters remain in place for the duration of the treatment course.
  3. Securing Catheters: The catheters are secured to your body to prevent movement and ensure consistent positioning for each treatment session.
• Treatment Sessions:
  1. Connection to Afterloader: For each treatment session, the ends of the implanted catheters are connected to a sophisticated machine called a "remote afterloader."
  2. Radiation Delivery: The afterloader precisely guides a single, powerful radioactive source (Ir-192) sequentially through each catheter for a few minutes. The duration and specific path within each catheter are meticulously calculated by the treatment planning system to deliver the prescribed high dose of radiation to the tumor.
  3. Source Retraction: After the programmed dose is delivered, the radioactive source is automatically retracted back into the afterloader.
  4. Disconnection: The catheters are then disconnected from the machine.
• Multiple Sessions: HDR brachytherapy typically involves a few treatment sessions (e.g., 2 to 5 sessions) delivered over several days or weeks. Patients may remain hospitalized between sessions with the catheters in place, or they may go home and return for each session, depending on the treatment protocol and hospital policy.
• Catheter Removal: Once all planned treatment sessions are completed, the catheters are carefully removed from the prostate. This is usually a simple procedure that does not require further anesthesia.
• No Special Precautions: Since the radioactive source is removed after each session and the catheters are removed at the end of the treatment course, there is no residual radioactivity in the patient's body. Therefore, no special radiation precautions are needed after HDR brachytherapy.
• Combination Therapy: HDR brachytherapy can be used as a standalone treatment, particularly for patients with intermediate to adverse prostate cancer. It is also frequently used in conjunction with a shorter course of External Beam Radiation Therapy (EBRT) to maximize tumor control, especially in more aggressive cases.

Both LDR and HDR brachytherapy offer excellent results for prostate cancer, and the choice between them depends on various factors, including the cancer's characteristics, prostate size, patient's overall health, and the expertise available at the treatment center. Your radiation oncologist will discuss which approach is best suited for your specific situation.

Understanding Results

Prostate brachytherapy demonstrates highly promising results in terms of both cancer control and maintaining a good quality of life for patients. Its targeted nature allows for effective eradication of cancer cells with minimized impact on surrounding healthy tissues.

• Efficacy and Cancer Control:

  • High Success Rates: Brachytherapy is particularly effective for early-stage and localized prostate cancer. Studies consistently show excellent rates of biochemical control (stable or declining PSA levels, indicating no cancer recurrence) over long periods.
  • Indian Context: In India, overall survival rates for men undergoing prostate brachytherapy typically range between 81% and 93%. These figures are comparable to global outcomes reported for radical prostatectomy (surgical removal of the prostate) and external beam radiation therapy, affirming brachytherapy's efficacy in the Indian healthcare landscape.
  • Tumor Control with Fewer Complications: Research suggests that brachytherapy can offer superior control of the tumor with a lower incidence of complications compared to some other treatment modalities. This balance of aggressive cancer treatment and reduced side effects is a significant advantage.
  • Long-Term Outcomes: Long-term follow-up studies consistently report high success rates for brachytherapy, especially for early-stage disease, with many patients remaining cancer-free for 10, 15, or even 20 years post-treatment.

• Quality of Life:

  • Preservation of Function: A key benefit of brachytherapy is its potential to preserve a patient's quality of life. The precise delivery of radiation aims to minimize damage to nerves and tissues responsible for urinary, bowel, and sexual functions, which can be significantly impacted by other treatments.
  • Reduced Recovery Time: Compared to surgery, brachytherapy typically involves a shorter recovery period, allowing patients to return to their normal activities more quickly.

• Post-Treatment Follow-up:

  • Regular PSA Monitoring: After brachytherapy, regular follow-up appointments are crucial. These typically involve periodic PSA (Prostate-Specific Antigen) blood tests to monitor for any signs of cancer recurrence. A rising PSA level could indicate a need for further investigation.
  • Physical Examinations: Your doctor will conduct physical examinations, including DREs, to assess your prostate and general health.
  • Symptom Management: Any lingering side effects, such as urinary or bowel symptoms, will be monitored and managed by your healthcare team to ensure your comfort and well-being.
  • Imaging Studies: Occasionally, imaging studies like MRI might be used in follow-up to evaluate the prostate and surrounding tissues.

Potential Risks and Side Effects

While prostate brachytherapy is generally associated with fewer severe side effects than radical surgery or traditional external beam radiation, it's important to be aware of potential risks and complications. Most side effects are temporary and manageable, but some can be long-lasting.

• Urinary Side Effects: These are among the most common, especially in the initial weeks or months after treatment.

  • Common Issues: Patients may experience increased urinary frequency (needing to urinate more often), urgency (a sudden, strong need to urinate), difficulty initiating urination, a weaker urine stream, pain or burning during urination (dysuria), and a sensation of incomplete bladder emptying. These symptoms usually improve over time as the prostate swelling subsides and tissues heal.
  • Less Common/More Severe Complications:
    • Urethral Stricture: A narrowing of the urethra (the tube that carries urine out of the body) can occur, leading to significant difficulty in urination. This might require further procedures to dilate or surgically repair the urethra.
    • Radiation Cystitis: Inflammation and scarring of the bladder lining due to radiation exposure, which can cause persistent urinary symptoms and discomfort.
    • Hematuria: Blood in the urine, usually mild and temporary, but sometimes requiring evaluation.

• Bowel Side Effects: These are generally less common and milder than urinary symptoms due to the precise targeting that spares the rectum.

  • Common Issues: Patients might experience rectal pain or discomfort, a burning sensation in the rectum, increased bowel frequency, diarrhea (sometimes with small amounts of blood or mucus), and rectal urgency. These symptoms often resolve within a few months.
  • Rare Complication:
    • Rectal Fistula: In very rare instances, an abnormal opening (fistula) between the rectum and another organ (e.g., urethra or skin) can occur, requiring surgical intervention.

• Sexual Dysfunction: Erectile dysfunction (ED) is a potential side effect, though often less severe than after radical prostatectomy.

  • Erectile Dysfunction (ED): Approximately 50% of patients may experience some degree of ED within five years of treatment. However, many men are able to maintain satisfactory sexual function with or without the aid of medications (e.g., PDE5 inhibitors like sildenafil or tadalafil) or other interventions. The onset of ED may be gradual over time.
  • Ejaculatory Function: While erectile function may be affected, ejaculatory function is often preserved. However, some men might notice a reduction in ejaculate volume, a change in ejaculate consistency, or a decrease in orgasm intensity.
  • Impact on Fertility: Brachytherapy can affect sperm production and quality, potentially leading to infertility. Patients concerned about fertility should discuss options like sperm banking before treatment.

• Other Side Effects:

  • Fatigue: Feeling tired or fatigued is a possible side effect, which can last for several weeks to months after the procedure.
  • Perineal Pain and Swelling: After the procedure, some patients may experience localized pain, tenderness, and swelling in the perineum (the area where the needles were inserted). This is usually manageable with over-the-counter pain medication, ice packs, and rest, and it typically resolves within a few days to weeks.
  • Rare Bladder Cancer: While extremely rare, there is a theoretical, albeit very small, increased risk of developing secondary bladder cancer many years after radiation therapy.

It is crucial for patients to have an open discussion with their healthcare team about these potential risks and side effects, as well as strategies for managing them. The medical team can provide personalized advice and support throughout the treatment and recovery process.

Costs in India

One of the significant advantages of opting for prostate brachytherapy in India is its remarkable affordability compared to many Western countries. This cost-effectiveness, combined with advanced medical facilities and experienced professionals, positions India as an attractive destination for medical tourism, particularly for complex treatments like cancer therapy.

The average cost of prostate brachytherapy in India typically ranges from ₹90,000 to ₹5,00,000 (approximately $1,080 to $6,000 USD). This broad range reflects various influencing factors.

Factors Influencing the Cost:

1. Type of Brachytherapy:

   • Low-Dose Rate (LDR) Brachytherapy: Generally, LDR brachytherapy, which involves a single procedure for permanent seed implantation, falls in the range of ₹90,000 to ₹1,80,000 (approximately $1,080 to $2,160 USD). This typically covers the seeds, procedure, and initial follow-up.
   • High-Dose Rate (HDR) Brachytherapy: HDR brachytherapy, which involves temporary implants and multiple treatment sessions, usually ranges from ₹1,20,000 to ₹2,50,000 (approximately $1,440 to $3,000 USD). The cost difference often accounts for the multiple sessions and the specialized equipment (remote afterloader) required.

2. Hospital and Location:

   • Infrastructure and Reputation: Renowned hospitals with state-of-the-art infrastructure, advanced technology, and a strong track record in oncology (especially in major metropolitan cities like Delhi, Mumbai, Bangalore, Chennai, Hyderabad) tend to have higher costs. These hospitals often provide a more comprehensive support system and cutting-edge equipment.
   • Geographical Location: Treatment in Tier 1 cities is generally more expensive than in Tier 2 or Tier 3 cities, due to higher operational costs and demand.

3. Oncologist's Expertise:

   • The experience, specialization, and reputation of the treating radiation oncologist or urologist can influence the overall pricing. Highly experienced and renowned specialists may charge higher consultation and procedural fees.

4. Number of Treatment Sessions:

   • For HDR brachytherapy, the total cost can vary based on the number of planned treatment sessions. A longer course with more sessions will naturally incur a higher overall expense.

5. Pre-operative Diagnostics and Imaging:

   • The cost estimate typically includes extensive pre-treatment tests and scans such as CT scans, MRI, TRUS, blood tests, and dosimetry planning. These diagnostic procedures are crucial for precise treatment planning and account for a significant portion of the initial expenses.

6. Post-operative Care and Follow-ups:

   • The overall cost package often incorporates charges for routine medicines, consumables used during and after the procedure, hospitalization days (if any), and initial follow-up appointments. Long-term follow-up costs (PSA tests, consultations) would be separate.

India's Position in Brachytherapy:

India is increasingly recognized for offering advanced brachytherapy facilities and highly experienced medical professionals. The country boasts a growing number of cancer centers equipped with modern brachytherapy units, staffed by skilled radiation oncologists and medical physicists. This availability, coupled with shorter wait times compared to many Western healthcare systems, makes it an attractive option for both domestic and international patients.

However, it is important to acknowledge a prevailing challenge within India's brachytherapy landscape. A survey indicated that despite the willingness of a majority of radiation oncologists in India to learn and adopt prostate brachytherapy, the lack of adequate training and necessary infrastructure are the most frequently cited reasons for it not being as popularly practiced across all regions. This highlights the need for continued investment in specialized training programs and equipping more centers with the required technology to broaden access to this effective treatment.

When considering prostate brachytherapy in India, it is highly recommended to obtain detailed cost breakdowns from multiple reputable hospitals and clarify what is included in the package. Many health insurance providers in India do offer coverage for cancer treatments, including brachytherapy, but it is essential to verify the specifics of your policy with your insurer well in advance.

How Ayu Helps

Ayu is dedicated to simplifying your healthcare journey by securely managing your medical records, appointments, and treatment plans, ensuring seamless coordination with your healthcare team throughout your prostate brachytherapy experience.

FAQ

1. Is prostate brachytherapy painful? The brachytherapy procedure itself is performed under general or spinal anesthesia, so you will not feel any pain during the treatment. After the procedure, you might experience some mild discomfort, pain, or swelling in the perineal area, which can usually be managed with over-the-counter pain relievers and typically subsides within a few days to weeks.

2. How long does recovery take after prostate brachytherapy? Recovery is generally quick. Most patients can return to their normal daily activities within a few days to a week after LDR brachytherapy. For HDR brachytherapy, recovery after the final session is also relatively fast, often within a few days. However, some urinary or bowel symptoms might persist for several weeks or months as tissues heal.

3. Will I be radioactive after brachytherapy? If you undergo Low-Dose Rate (LDR) brachytherapy, the radioactive seeds remain permanently in your prostate. You will emit low levels of radiation, which diminish over time. Your doctor will provide specific temporary precautions, such as avoiding prolonged close contact with pregnant women and young children for a few weeks or months. For High-Dose Rate (HDR) brachytherapy, the radioactive sources are removed after each session, and the catheters are removed at the end of the treatment course, so you are not radioactive afterward, and no special precautions are needed.

4. Can I have sex after prostate brachytherapy? Sexual activity can usually be resumed a few weeks after brachytherapy, once any initial discomfort has resolved. However, it's important to discuss this with your doctor, as individual recovery times can vary. While erectile function may be preserved, some men might experience erectile dysfunction or changes in ejaculatory volume over time. Medications can often help manage ED.

5. What are the long-term side effects of prostate brachytherapy? Long-term side effects can include persistent urinary symptoms (frequency, urgency, weaker stream), bowel changes (rectal urgency, occasional diarrhea), and erectile dysfunction. While these are usually less severe than with some other treatments, they can occur. Regular follow-up with your doctor is important for managing any persistent side effects.

6. Is brachytherapy suitable for all prostate cancer stages? No, prostate brachytherapy is primarily suitable for men with localized prostate cancer, particularly those with low-to-intermediate-risk disease. It may also be used in combination with external beam radiation for intermediate to high-risk localized disease. It is generally not recommended for advanced or metastatic prostate cancer (cancer that has spread beyond the prostate).

7. How often do I need follow-ups after brachytherapy? Follow-up schedules typically involve regular PSA blood tests and physical examinations every few months initially, gradually extending to once or twice a year. The frequency and duration of follow-ups will be determined by your oncology team based on your specific case and response to treatment.

8. What are the alternatives to prostate brachytherapy? Alternatives to prostate brachytherapy for localized prostate cancer include:

• Active Surveillance: Monitoring the cancer with regular PSA tests and biopsies for very low-risk cases.
• External Beam Radiation Therapy (EBRT): Radiation delivered from outside the body over several weeks.
• Radical Prostatectomy: Surgical removal of the prostate gland.
• Hormone Therapy: Often used in conjunction with radiation for higher-risk cases.
• Cryotherapy or HIFU (High-Intensity Focused Ultrasound): Less common focal therapies. The choice depends on cancer characteristics, patient health, and personal preferences.