What an informed patient should know about prostate seed implant:
Radiation kills cancer cells by interfering with their ability to reproduce. The radiation oncologist places the metallic radioactive "seeds"; (either Iodine 125 or Palladium 103) into the prostate gland guided by ultrasound. The placement of these seeds gives a dose of radiation to a small area, minimizing damage to the surrounding tissue. Studies have shown that these seeds effectively destroy cancer cells.
Preparing for the implants:
At The Harold Leever Regional Cancer Center, Iodine 125 (I-125) or Palladium 103 (Pd-103) is used for prostate seed implant. The implant procedure takes place in the nearby St. Mary’s Hospital. Before placing the implants, a physician will order an ultrasound of the prostate called a volume study. This will help determine the size and shape of the prostate. The volume study also will help determine the number of seeds to be placed into the gland. A CTscan of the pelvis is also obtained to evaluate the prostate cancer. These procedures are performed so that the medical team of physicians and medical physicists/dosimetrists can formulate a precise treatment plan.
Before the surgery, the information about the hospital stay and specific instructions regarding diet changes, medications and bowel preparation to empty the rectum are provided, so that the ultrasound pictures used during the procedure will be clearer. Preparations also may include basic preoperative studies such as a chest X-ray, an electrocardiogram and routine blood work.
The implant procedure:
Ultrasound probe in
rectum for needle guidance
The procedure is done in St. Mary’s Hospital under spinal or general anesthesia and lasts about one hour. A catheter will be placed into the bladder. Thin needles are passed into the prostate through the perineum (the skin between the scrotum and rectum). An ultrasound probe, which is placed into the rectum, allows the radiation oncologist and urologist to accurately place the needles. Once the needles have been placed, they are pulled out, leaving the "seeds" behind. Then the rectal ultrasound probe is removed.
18 gauge (1.3 mm diam) needle for seed placem
Patients then go to the recovery room for about one hour followed by the “same-day surgery” room for an additional 2 hours. A urine catheter remains in place for the first 24 hours after implant and is removed when the patient visits the urologist’s office the day after the seed implant. Once patients recover from anesthesia, they can go home. There is actually little discomfort associated with the implant, but medications are available if necessary. Patients should not drive for 24 hours after the implant, so someone should take them home. Specific instructions regarding side effects, symptom management, medications and follow-up appointments are given to patients before they leave the hospital.
About 4 weeks after implant, patients return to The Harold Leever Regional Cancer Center for a CT scan of the prostate. These studies are necessary to verify the accuracy of the implant.
Patients are given detailed discharge instructions. In general, they can return to regular activities in about a week. They can follow their normal diets and resume routine medications unless otherwise instructed.
Because the seeds contain low-energy radioactive sources and are surrounded by a metallic covering, patients are slightly radioactive (see FAQ, below). The amount of radiation in the prostate does not prevent them from carrying on ordinary activities. However, for the first two months following the implants, patients should increase by a few feet the distance between themselves and others, especially pregnant women and small children.
Late Side Effects:
After the initial healing from the implant, most of the side effects are related to the radiation from the seeds that were placed into the prostate. The radiation may cause inflammation and swelling in the prostate. This may result in frequent urination, burning with urination, urinary urgency and a weaker urine stream. These symptoms can last from one to four months. Drinking plenty of fluids, as well as avoiding foods and beverages containing caffeine may help. If the symptoms persist, a physician may prescribe medication to help.
Patients are scheduled for a physician visit about 3 months after the procedure. It is important to return to see both the urologist and radiation oncologist for evaluation. Each physician assesses the patient's progress and will address any problems. Patients are then seen at regular intervals over a period of years.
Frequently Asked Questions:
1. How big is a I-125 seed? About the size of a grain of rice! See the figure to the right displaying the seed placed on an index finger.
2. How Radioactive am I? After your radioactive seed implant, the radiation around you is at a low and safe level for others. Still, you can take a few precautions to further lower these levels and the risk of exposure to others. You should avoid prolonged physical contact with pregnant women and young children (such as holding them or having them sit on your lap) for 2 months following the I-125 implant However, it is safe to greet someone with a brief hug, kiss or handshake. The graph to the right shows the % of the radioactivity that remains the prostate volume after the seed implant.
3. Do the items I touch become radioactive? No. Your touch does not contaminate anyone or anything. Your family may use the same linens, clothing, tableware, dishes, and toilet facilities that you use without taking any special precautions. Airline travel is safe. Your bodily wastes (urine and stool) are NOT radioactive. The seeds will not interfere with pacemakers or microwave ovens.
4. How does the group of the implanted I-125 seeds look like inside of my prostate? See figure to the left which displays I-125 seeds in the pelvis. At The Harold Leever Regional Cancer Center stranded seeds are used to help safeguard the localization and spacing among the seeds.
5. Is it safe to sleep with my spouse? Yes. It is safe to sleep with your spouse and continue to have sexual relations. Your sperm may be discolored dark brown to black. This is normal and is the result of bleeding that may have occurred during the implant and is now being released into the ejaculate.
6. In the future, should I notify my health care provide of the prostate seed implants? Yes. Be sure to tell other health care providers that you have had radioactive prostate seed implants. In most cases, the radioactive seeds will not be of concern. However, invasive procedures of the prostate or area around the prostate could have an effect on the seeds or the person performing the procedure.
If you have any questions, please speak with your radiation oncologist or nurse at The Harold Leever Regional Cancer Center. They may be reached at 203-575-5555.
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