When a man has prostate cancer that has not spread to other parts of his body, he can refuse treatment, or accept extensive surgery, radioactive seeds put permanently into his prostate called brachytherapy, or beam radiation. I rarely recommend beam radiation is it destroys everything in its path randomly and often causes chronic diarrhea, chronic pelvic pain, incontinence and impotence.

Brachytherapy involves permanent placement of radioactive seeds shot by a gun into the prostate. Prostate cancers are graded moderate and severe. Brachytherapy is recommended only for moderate prostate cancer. Moderate is defined as: * not spread beyond the prostate gland (T1 or T2 tumor), * cells that do not look very malignant under the microscope (Gleason score of 6 or lower), * serum PSA level of 10 ng/mL [ µg/L] or less)

In research so far, from 13 case series and 3 cohort studies, acute urinary retention was reported in 1–14 percent of patients. Long-term side effects occurred in fewer than five percent of patients and included urinary incontinence, cystitis, urethral strictures and proctitis. Sexual potency was maintained after implantation in 86-96 percent of patients. These results are better than those for radical surgery. At present, most doctors still recommend surgery and feel that brachytherapy is still an experimental procedure. See report #1434.

Juanita Crook, Himu Lukka, Laurence Klotz, Nancy Bestic, Mary Johnston, and the Genitourinary Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative. CMAJ 2001;164(7):975-81

Reported 4/15/01; checked 8/9/05

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