Minimally invasive radiation therapy for prostate cancer
Brachytherapy in the center of Munich
Outpatient, minimally invasive therapy for localized prostate cancer in urology at the Residenz
Dr. Friedemann Meisse has been working as a specialist in urology in Munich for many years and, since 2002, has specialized in the outpatient treatment of prostate cancer with LDR brachytherapy (low dose rate brachytherapy), among other things. After many years as chief physician in the brachytherapy department at a renowned urology clinic in Munich, Dr. Friedemann Meisse is one of the most experienced brachytherapists in Europe, having performed over 3,000 seed implantations.
This means that we can guarantee the greatest possible experience in Munich for the benefit of our patients, ensuring a quick recovery and return to normal life.
In contrast to bureaucracy-overburdened clinics with often long waiting times for brachytherapy treatment of prostate cancer, as a urological practice in the center of Munich, our team has been able to offer patients prompt and flexible seed therapy (brachytherapy) with state-of-the-art technology and the greatest possible expertise on an outpatient basis in our own operating room in Munich since June 2025.
Dr. Friedemann Meisse, specialist in urology, is one of the most experienced brachytherapists in Europe.
Introduction to Brachytherapie Munich
Prostate cancer is one of the most common malignant tumors in men worldwide and is one of the most common causes of cancer-related deaths. In Central Europe alone, more than 300,000 men are diagnosed with prostate cancer every year. If the cancer is diagnosed early and is still confined to the prostate, LDR brachytherapy (seed implantation) offers an excellent chance of cure, ranging from 80 to 95 percent depending on the stage.
The following always applies: the earlier prostate cancer is detected during urological cancer screening in men, the better the chances of recovery. This is yet another argument in favor of every man aged 45 and over visiting a urologist once a year for preventive screening!
In contrast to the US, in Europe and Germany, men with prostate cancer are still primarily treated with radical surgical removal of the prostate (radical prostatectomy), often with serious side effects such as urinary incontinence - due to sphincter damage or impotence due to nerve damage – not to mention the usual surgical risks such as bleeding, infection, wound healing disorders, thrombosis, embolism, scarring, and a hospital stay of several days.
This is why we believe it is all the more important to inform patients in our urology practice in Munich in advance about all relevant treatment options and to familiarize them with the respective side effect profiles, risks, and chances of success before a final decision on therapy is made.
LDR brachytherapy with seeds is one of the most minimally invasive prostate cancer treatments available, as clearly demonstrated by international data collected over many years in medical studies.
Among other things, the advantage of this treatment is that it can be performed on an outpatient basis in a single session at our practice in Munich without long waiting times and, from a radiation biology perspective, it meets all the requirements for effective and high-precision radiation therapy, as it irradiates the cancer in a highly conformal (organ-limited) manner.
This means that neighboring organs such as the intestine and bladder can be significantly better protected from unnecessary radiation exposure than with external radiation. This is particularly true for the sphincter muscle, which is responsible for maintaining urinary continence, and for the nerve pathways responsible for male potency.
They are largely spared from radiation-induced damage due to the short range of the seeds.
Minimally invasive therapy technique: LDR brachytherapy (low-dose-rate seed implantation) in the center of Munich
A very modern and innovative treatment method for prostate cancer in urology is LDR brachytherapy (permanent seed implantation).
In a single therapy session at our practice in Munich, mini-radiation implants, known as seeds, are placed in the prostate with high precision under sedation (anesthesia) using tiny hollow needles and under X-ray, ultrasound, and computer control to ensure that the cancer cells are irradiated with pinpoint accuracy.
The range of the gamma radiation emitted by a single seed in the tissue is only a few millimeters. This procedure therefore ensures radiation cancer therapy that is tailored to the patient and thus strictly "individualized," while maximally protecting the bladder, rectum, and vascular nerve pathways from barely measurable scattered radiation.
Seed implantation is a minimally invasive treatment for prostate cancer. It's done on an outpatient basis and has strict legal requirements for staff and facilities, which our practice in Munich meets, of course.
With a very low overall side effect profile, there may be a temporary increase in urinary urgency symptoms immediately after brachytherapy treatment.
Radiation-induced changes in the rectum and bladder are extremely rare compared to external radiation therapy due to the short range of the seed implants.
Urinary incontinence occurs in less than one percent of cases. Potency remains unchanged in the short term after seed implantation. Seven years after implantation, approximately 30 - 40 percent of treated patients may experience a decrease in sexual performance (impotence).
According to national and international data, permanent LDR brachytherapy is often safer and gentler than external radiation therapy (ERBT) or temporary (short-term) high-dose brachytherapy (HDR), in which a high dose of radiation is administered within a short period of time, usually within a few minutes or hours. In addition, LDR brachytherapy does not expose family members to any radiation. According to the results of international studies, brachytherapy is now considered an established, highly effective treatment for organ-confined prostate cancer.
Contrary to claims made by some, alternative treatment methods such as surgical removal of the prostate (radical prostatectomy - RPE) or external radiation (ERBT/IMRT) do not show better cure rates for the treatment of prostate cancer in comparable tumor stages - according to international literature!
Principle of brachytherapy treatment (seed implantation) in Munich
After ultrasound-guided, computer-assisted, three-dimensional dose planning, rice grain-sized, titanium-coated radiation bodies (seeds) filled with radioactive iodine 125 (radionuclide) and coated with titanium are deposited using special hollow needles via the patient's perineum, guided by ultrasound and, if necessary, X-ray imaging, precisely at the previously calculated target location in the prostate.
The seeds are connected to one other via threads (called strands) to prevent them from slipping or migrating. The short distance between the radiation source (seeds) and the prostate essentially damages the genetic material (DNA) of the cancer cells, causing them to die and preventing them from dividing and multiplying.
The implanted seeds remain permanently in the prostate and are not removed later. The half-life of the implanted iodine seeds is approximately six weeks, which means that after three months, the radiation intensity has fallen to 25 percent of the initial activity. Irritating symptoms such as increased day and night-time urination (pollakiuria/nycturia) or irregular bowel movements are sometimes observed, especially at the beginning. These usually subside very quickly as the radiation intensity decreases and disappear completely within the first six months, provided that the symptoms are perceived as troubling by the patient, immediately after brachytherapy.
In contrast to external radiation (e.g. 3D conformal external radiation, proton radiation, CyberKnife), the ionizing gamma radiation used in brachytherapy is concentrated in the target organ (the prostate) and does not penetrate other organs (e.g., the bladder, intestines, skin), so that neighboring organs, especially the rectum and bladder, can be protected from radiation damage to the greatest extent possible. The success of brachytherapy (as with all therapeutic procedures) is essentially determined by the postoperative PSA progression. In contrast to surgery, where the PSA level should drop to near-zero after surgical removal of the prostate, the PSA level falls at different rates after successful radiation therapy and ideally reaches a value ≤ 0.5 ng/ml.
As part of a phenomenon known as rebound, the PSA level may rise again temporarily within the first two years after brachytherapy following a postoperative decline. This phenomenon is not considered a recurrence (i.e., the cancer coming back) and therefore usually does not require further diagnostic or therapeutic attention.
In which scenarios is brachytherapy beneficial?
LDR brachytherapy is particularly recommended in accordance with American and European guidelines (EUA/AUA/ABS-American Brachytherapy Society, NCCN guidelines, Estro/EORTC/ASTRO guidelines) as the sole therapy (known as monotherapy) or in combination with external radiation in high-risk groups, provided that the prostate cancer is confined to the organ (locoregional).
As a sole therapy (known as monotherapy), LDR brachytherapy is used in the following cases:
Low-risk/low-intermediate prostate cancer (low-risk cancer) with the following clinical criteria:
- PSA < 10-20 ng/ml
- Histological Gleason score 6 / 7a
- Organ volume < 60 ml
As combination therapy: Patients who have an unfavorable,intermediate, or high-risk profile (PSA > 20 or Gleason score 7b, 8) can be successfully treated with combination therapy, which initially involves dose-reduced external radiation therapy (ERBT) followed by dose-reduced seed implantation (LDR brachytherapy). Any inflammatory diseases of the intestine and bladder should be ruled out, especially before external radiation therapy, but also to a limited extent before brachytherapy.
Results
Brachytherapy alone (monotherapy):
According to the available study results, LDR brachytherapy as monotherapy achieves a PSA progression-free cure rate of over 94 percent and a 10-year cancer-specific survival rate of 99 percent in low-risk tumors and tumors in the favorable intermediate risk group. This treatment method is therefore absolutely equi-effective (equivalent) in terms of success rate compared to radical prostatectomy (radical removal of the prostate) or .
The histologically confirmed local recurrence rate after brachytherapy in the event of a PSA increase is approximately 15 percent (for comparison: after radical prostatectomy, 17 to 40 percent of all patients with clinically localized prostate cancer have a PSA recurrence after 10 years; 2 to 21.5 percent of patients who have undergone surgery for clinically localized prostate cancer have a local recurrence within three to 15 years after radical surgery).
Combination therapy: external radiation and brachytherapy (boost) for high cancer risk:
For patients with locally confined prostate cancer of unfavorable-medium (Gleason 7b) and high risk (Gleason ≥ 8-10, PSA > 20 ng/ml), the multicenter, prospective, randomized ASCENDE-RT study published in 2017 involving nearly 400 male patients showed highly significant superiority of combination therapy consisting of external radiation (EBRT) followed by LDR brachytherapy, each with a reduced radiation dose and a total of 12 months of androgen suppression, compared to external radiation therapy (EBRT) alone with androgen suppression (PSA-free survival after 9 years of 83.3 percent in the combination therapy group compared to 62.4 percent in the group receiving external radiation therapy alone; stratified according to surgical staging, PSA > 0.2 ng/ml: PSA-free survival after 9 years 82.2 percent in the combination group compared to 31.5 percent in the EBRT group).
Focal salvage brachytherapy in the event of disease recurrence after previous radiation therapy:
If, after external percutaneous radiation therapy of the prostate or after LDR brachytherapy, there is a recurrence of cancer, usually in the form of a renewed increase in PSA in the blood serum (local recurrence) in the prostate, the new tumor growth can be treated with another round of LDR brachytherapy (called focal salvage brachytherapy) if the situation is right. This involves putting individual seeds into the tumor that came back.
A prerequisite for salvage brachytherapy is that the location and extent of the recurrent tumor can be visualized in advance using modern imaging techniques (PSMA-PET-MR) and that the recurrent tumor has also been confirmed histologically by a biopsy.
If there are no significant long-term side effects from the initial radiation therapy and the location of the recurrent tumor is favorable, targeted image-guided selective brachytherapy of this single focus (known as focal salvage brachytherapy) can be considered.
In contrast, this therapy cannot be repeated after radical prostate surgery. Only LDR brachytherapy offers the possibility of minimally invasive second-line treatment in the event of cancer recurrence. This is also a major advantage!
In summary, seed implantation as performed in our practice in Munich offers the following advantages:
- LDR brachytherapy is usually performed once as a monotherapy and is a minimally invasive prostate cancer treatment that can be performed on an outpatient basis. This means that the patient can leave our practice after a 60-minute treatment session.
- In terms of radiation biology, the implanted emitters (seeds) ensure a high and effective radiation dose in the cancer-exhibiting organ while maximally protecting the neighboring organs (intestines/bladder) from harmful radiation due to their short range.
- Based on good available data, brachytherapy has now established itself in the US and Europe as one of the three preferred treatment methods for localized prostate cancer, alongside external radiation and radical prostate surgery.
- Comparing the currently available 10 to 15-year follow-up data after radical surgical removal of the prostate and after external radiation in terms of cancer cure rates, brachytherapy shows absolutely equally good and equally effective cure rates.
- The risk of urinary incontinence (involuntary loss of urine) as a result of injury to the external bladder sphincter is virtually eliminated with brachytherapy (< 0.2 percent), unlike with surgical prostate removal; urinary continence is maintained in all cases.
- Spontaneous erectile function (potency rate) of the male penis is preserved in approximately 60 percent of cases after brachytherapy, while according to the specialist literature, impotence can occur in up to 80 percent of cases after prostate surgery.
- The short duration of treatment and the low rate of intra and post-operative complications allow patients to quickly regain their independence in everyday life with early post-operative social reintegration.
- Due to the good results, LDR brachytherapy (low-dose-rate seed implantation) is also a successful treatment option for locally advanced prostate cancer in stages ≥Gleason 7a/7b as monotherapy or in combination with adjuvant (additional) external radiation therapy (ERBT = external radio beam therapy) with a reduced radiation dose.
- Brachytherapy requires only a single treatment session, unlike external radiation, which usually requires the patient to undergo radiation once a day for four to six weeks, which can be very time-consuming and tedious for the patient.
- Unlike external radiation therapy or radical prostatectomy, LDR brachytherapy is currently the only prostate cancer treatment that can be used again if the cancer returns (known as cancer recurrence). After all other treatment methods (external radiation therapy/surgery), only medication or other, often more aggressive treatment options can be used in the event of cancer recurrence. Advantages of treatment at the urology center in Munich at the private practice of Dr. Friedemann Meisse
- As the long-standing chief physician of the brachytherapy department at a Munich clinic, Dr. Friedemann Meisse has performed well over 3,000 seed implantations since 2002, making him one of the most experienced brachytherapists in Europe. For this highly specialized therapy, patients from all over Germany are referred to Dr. Meisse by urology and radiation therapy specialists, as well as by colleagues from abroad.
- In contrast to bureaucracy-overburdened clinics with often long waiting times for brachytherapy treatment of prostate cancer, as a urological practice in the center of Munich, our team has been able to offer patients prompt and flexible seed therapy (brachytherapy) on an outpatient basis with state-of-the-art technology and the greatest possible expertise since June 2025.
- On the day of treatment, we ensure a pleasant treatment atmosphere in our practice in Munich, as there is no normal practice routine on this day – in other words, the patient scheduled for brachytherapy is the only patient in our practice and is cared for individually by our brachytherapy team.
- As a private urology practice in Munich, we are also happy to offer brachytherapy to patients with statutory health insurance on a self-pay basis. Please contact our practice for the costs.
- For foreign self-pay patients, we also offer treatment on Saturdays at our practice in Munich if scheduling difficulties arise.
- Dr. Friedemann Meisse in Munich is one of the few urologists in Germany who has specialist expertise in radiation protection for brachytherapy with iodine seeds and is therefore authorized to perform this specialized medical treatment. The personal and location-specific license to handle radioactive substances, as well as the strict requirements for spatial and technical equipment, have been reviewed by the State Office for the Environment and granted to our practice in Munich.
- Dr. Meisse is also the radiation protection officer in his own practice in Munich for the medical field of brachytherapy.
- Our practice is located in the center of Munich, which means we have excellent transport links and are very easy to reach. Patients traveling from far away or from abroad can reach us easily and conveniently via Munich's well-maintained public transport network.
