Using Cesium-131 for prostate cancer

How effective is brachytherapy for prostate cancer with Cesium-131?

Brachytherapy for prostate cancer is a compelling, out-patient option with excellent outcomes data, and swift resolution of side effects in many cases.

A Decade of Data Shows the Value of Cesium-131 Brachytherapy for Prostate Cancer Treatment

The peer reviewed publication, Long-term Biochemical Outcomes Using Cesium-131 in Prostate Brachytherapy, is drawing attention for its positive report on a study of the ten-year findings on the impact of Cesium-131 internal radiation therapy in treating a series of cancer patients.

The publication reported on a study of a series of 571 patients who were treated with Cesium-131 prostate brachytherapy at the Chicago (IL) Prostate Cancer Center by radiation oncologist Dr. Brian J. Moran. The overall group was composed of 55% low risk, 36% intermediate risk, and 9% high risk localized prostate cancer patients as defined by National Comprehensive Cancer Network guidelines.

The overall ten-year biochemical success rate for the entire group was 96.2%. This was the largest and longest followed series of Cesium-131 treated patients reported to date.

Dr. Moran stated: “This is the largest and longest followed series of Cesium-131 treated patients reported to date. Given the notable biochemical outcomes, we view Cesium-131 as an excellent option for patients with localized prostate cancer, which is particularly noteworthy in light of the large component of intermediate risk patients in this series.”

Know All of Your Treatment Options Including Brachytherapy for Prostate Cancer

In conversations with prostate cancer survivors and the physicians that treat them, we hear again and again how important it is for patients to know about all of their options, including brachytherapy for prostate cancer, if they want to receive effective treatment while maintaining the best quality of life possible.

Cesium-131 Treatment Areas

For my patients, I use Cesium-131 instead of Iodine because most of the effective isotope life is spent in 4-5 wks, compared to the 60-day half-life of Iodine,” he said. “Iodine will still be putting out a pretty good dose of radiation 8 or 9 months later. My patients have a shorter duration of acute uropathic complaints because of that.

Dr. Bradley Prestidge

Dr. Bradley Prestidge
Radiation Oncologist

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Acceptable side effects comparable to other treatments (1)

  • Less impact on urinary function than surgery (1)
  • Higher degree of sexual function reported at three year follow up(1)
  • 45 minutes to 1 hour for complete implant
  • Hospitalization rarely required
  • First ultrasound guided implant performed in 1985
  • Local control rates up to 99% of patients in long term studies (5)

Robotic Prostatectomy

Acceptable side effects comparable to other treatments (1)

  • Very few GI or rectal side effects have been reported.
  • Higher degree of poor urinary function(1)
  • Higher degree of sexual dysfunction (1)
  • 3-4 hours procedure
  • Up to a 4 day hospital stay
  • Early reports of robotic surgery began in 2003 (2)
  • 83% local control rates achieved at high volume centers (4)

External Beam Radiation

Acceptable side effects comparable to other treatments (1)

  • Late rectal morbidity likely (3)
  • Urinary bother occurs in 12-40% of patients treated (3)
  • Approximately 78% of patients maintain sexual function (6)
  • Five days per week for up to nine weeks.
  • Hospitalization is rarely required
  • IMRT adaptation acceleration began in 2003
  • 89% of patients in local control rates in long term study (3)

Brachytherapy Effectively Treats Prostate Cancer

Prostate brachytherapy with Cesium-131 places cancer-fighting medical radioisotopes in and/or around the prostate, as close to the cancer as possible. The isotopes are encased in capsules the size of a grain of rice and release a personalized radiation dose over a period of days. This allows the effective treatment of the prostate while minimizing side effects and damage to nearby tissue.

A comprehensive review of the literature comparing risk stratified patients by treatment with long-term follow-up, Grimm et al, provided a visual comparison of different treatments for prostate cancer.

Brachytherapy Prostate Treatment Low Risk
Brachytherapy Prostate Treatment High Risk

Quality of life expectations following Cesium-131 brachytherapy for prostate cancer

The short half life of Cesium-131 delivers treatment quickly to the patient, and allows the patient to recover quickly. As seen below, studies have shown that the patient IPSS will return to baseline faster than following brachytherapy with either Iodine and Palladium. This gives patients the opportunity to put treatment behind them, and move beyond their cancer.

Chart of quality of life post implant following Cesium-131 brachytherapy for prostate cancer


1. Benoit, et al., “Five Year Prostate Specific Antigen Outcomes after Cesium Brachytherapy”, Clin Onc, 26 (2014) 776-780.
2. Grimm, et al., "Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy" BJUI, 10951, 2012 p 22-29.
3. ArmpillaC, Dale R, Coles I, et al. The determination of radiobiologically optimized half-lives for radionuclides used in permanent brachytherapy implants. Int J Rad Onc Bio Phys 2003; 55:378-385.
4. Shah AB, et al. A Comparison of AUA Symptom Scores following Permanent Low-Dose-Rate Prostate Brachytherapy with lodine-125 and Cesium-131.
5. Bice, W. "Permanent prostate brachytherapy using Cs-131 for localized prostatic carcinoma: a phase II study." Presented at the 2008 Cesium Advisory Group Meeting November 2008. Tuscon, Arizona, U.S.A.
6. Keyes M, et al. "Predictive factors for acute and late urinary toxicity after permanent prostate brachytherapy: long-term outcomes in 712 consecutive patients." International Journal of Radiation Oncology, Biology and Physics 73(4):1023-32, 2009.
7. Ash D, et al. "A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer." Radiotherapy and Oncology 84(2):145-9, 2007.
8. Jacobs BL, et al. Acute lower urinary tract symptoms after prostate brachytherapy with Cesium-131. Urology 75(5):1143-7, 2010.
9. Prestidge B.R., Bice W.S., Jurkovic I., et al. Cesium-131 Permanent Prostate Brachytherapy: An Initial Report. Int. J. Radiation Oncology Biol. Phys. 2005: 63 (1) 5336-5337.
10. Neill B, et al. The Nature and Extent of Urinary Morbidity in Relation to Prostate Brachytherapy Urethral Dosimetry. Brachytherapy 2007:6(3)173-9.
11. Musmacher JS, et al. Dosimetric Comparison of Cesium-131 and Palladium-103 for Permanent Prostate Brachytherapy. Int. J. Radiation Oncology Biol. Phys. 2007:69(3)5730-1.
12 Yaparpalvi R et al. Is Cs-131 or 1-125 or Pd-103 the "deal" Isotope for 12. Yaparpalvi R, et al. Is Cs-131 or 1-125 or Pd-103 the "Ideal" Isotope for Prostate Boost Brachytherapy? A Dosimetric View Point. Int. J. Radiation Oncology Biol. Phys. 2007:69(3) 5677-8.
13. Sutlief S, et al. Cs-131 Prostate Brachytherapy and Treatment Plan Parameters. Medical Physics 2007:34(6)2431.
14. Yang R, et al. Dosimetric Comparison of Permanent Prostate Brachytherapy Plans Utilizing Cs-131, I-125 and Pd-103 Seeds. Medical Physics 2008:35(6)2734.
15. Prestidge B, et. al. Clinical Outcomes of a Phase-II, Multi-institutional Cesium-131 Permanent Prostate Brachytherapy Trial. Brachytherapy. 2007: 6 (2)78.
16. Moran B, et al. Cesium-131 Prostate Brachytherapy: An Early Experience. Brachytherapy 2007:6(2)80.
17. Jones A, et al. IPSS Trends for Cs-131 Permanent Prostate Brachytherapy. Brachytherapy 2008:7 (2)194.
18. DeFoe SC, et al. Is There Decreased Duration of Acute Urinary and Bowel Symptoms after Prostate Brachytherapy with Cesium 131 Radioisotope? Int. J. Radiation Oncology Biol. Phys. 2008:72(S1)5317.
19. Bice W, et. al. Recommendations for permanent prostate brachytherapy with 131Cs: a consensus report from the Cesium Advisory Group. Brachytherapy 2008:7(4)290-296.
20. Platta CS, et al. Early Outcomes of Prostate Seed Implants with 131Cs: Toxicity and Initial PSA Dynamics from a Single Institution. Int. J. Radiation Oncology Biol. Phys. 2008:72(S1)5323-4.

United States Brief Statement

Cesium-131 brachytherapy seeds are indicated for the treatment of malignant disease(e.g., head and neck, eye, brain, breast, prostate, etc.) and may be used in surface, interstitial, and intra cavitary applications for tumors with known radio sensitivity. The seeds may be used as a primary treatment or in conjunction with other treatment modalities, such as external beam radiation therapy, chemotherapy or as treatment for residual disease after excision of primary tumors. Contraindications: As with other brachytherapy sources, treatment of tumors in generally poor condition (e.g. ulcerated) is not recommended with Cesium-131 brachytherapy seeds due to the potential for source migration. Prior to use, please reference the Cesium-131 Instructions for more information on indications, contraindications, warnings, all precautions, and adverse events.

Caution: Federal law restricts this device to sale by or on the order of a physician.