The ideal patient for radioactive seeds is a man who is also ideally suited for external-beam radiation therapy and radical prostatectomy—and both of these treatments can cure prostate cancer in men with localized disease. So the question is, is interstitial brachytherapy equally good or better? And the answer for now is, probably not, although the treatment is continually improving. Before the development of sophisticated guidance systems, major problems arose from seeds being either too far apart or too close together, resulting in an uneven distribution of radiation throughout the prostate—some cancer cells were killed, but some weren’t. In many cases, the cancer returned, or never completely went away in the first place. Better placement may change this picture.
Radiation seeds are not recommended for men who have had a previous TUR procedure; for one thing, because they’ve had significant amounts of tissue around the urethra removed to alleviate their BPH symptoms, there’s not a lot left to hold the seeds in place. Perhaps because of this, men who have had a TUR are much more likely to develop urinary problems from this therapy.
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