Brachytherapy Brachytherapy or “seed implantation” is a procedure involving placing tiny, radioactive seeds, about the size of a grain of rice, directly into the prostate and tumor, while minimizing surrounding tissue radiation. In this usually outpatient procedure, the seeds are placed all in one setting, under anesthesia. The procedure includes use of trans-rectal ultrasound to guide placement of the seeds accurately in the prostate.  In general two types of prostate brachytherapy are available, “Real Time Brachytherapy” and “Pre- planned Brachytherapy”.  Real Time Brachytherapy is conceptually more accurate and may have improved outcomes over Pre-Planned Brachytherapy. Advantages of Brachytherapy This modality is minimally invasive.  The entire radiation is placed in one setting, and does not require daily visits to the radiation facility.  It is relatively pain free.  Most patients can go home the same day or stay in the hospital over-night.   Disadvantages or risks of Brachytherapy Patients with a prostate size greater than 50 grams are generally not eligible.   Some patients may require hormone therapy and/or short course of external radiation in conjunction.  It may take up to two years after radiation to know if the cancer has been successfully treated or not.  Success of radiation depends on how low the PSA reaches after treatment, and PSA may not reach its lowest point for up to 24 months after seed implantation.  This protracted time period may cause some anxiety in a patient’s mind, not knowing if he is clear of cancer or not.        Some men may experience painful urination, burning of urination, urinary frequency and frequent urges to go to the bathroom.  Some may develop urinary retention, difficulty passing their urine and need to wear a catheter.   Very occasionally urinary incontinence may occure. Some men may develop impotency, or decreased potency.  There is a small risk of loss of fecal control, increased number of bowel movements per day, and blood in the stool.