Temporary Side Effects

   

Once the radioactive sources have been placed into your prostate, some effects on the urinary system may become noticeable.  This is due to the irritating effects on the cells that line the urethra as it passes through the prostate (Fig. 1 Prostate Anatomy)

Most men who do have side-effects from the treatment report urinary side-effects.  The side-effects peak one month after the procedure and gradually improve over the next three to nine months.  Very rarely (in less than 1 in 10 patients) a temporary urinary catheter may need to be placed for about one to seven days due to a patients inability to urinate.

The possible urinary side effects include:

The side-effects improve on their own in the vast majority of men.  Medications that relax the urethra and allow more effective urination help improve these symptoms when present.  The class of medications are called alpha-blockers and include medications such as tamsulosin (Flomax), silodosin (Rapaflo) and terazosin (Hytrin)   

International Prostate Symptom Score (IPSS)

The IPSS is a questionnaire that assigns a number value to the level of irritative and obstructive urinary symptoms that you may be experiencing.  It ranges from a score of 0 (no symptoms) to 35 (severe symptoms).  It is a useful way of tracking how well the urinary side effects are improving over time.  Figure 4 shows how the side-effects resolve in men over time (measured in weeks).  By 8 months, most men have had their urination return to normal.

Long Term Side Effects

Unlike the temporary side effects, long term side effects are rare.  In most published data, from centers that do a large volume of seed implantation, the likelihood of significant long term urinary problems that require some subsequent hospitalization or procedure is less than 5%. Even when all cases are taken together from expert and non-expert institutions, the likelihood of long term complications from brachytherapy appear to be the lowest. Possible long term side effects include scar tissue formation in the urethra which causes weakening of the urinary stream, occasional painless passage of streaks of blood in the urine and periods of increased urinary frequency or urgency.

Fig 5.  Proportion of men who fail to return to their normal urination over time after seed implantation for prostate cancer