What to Expect
There are two steps in a prostate brachytherapy procedure:
Step 1 – Treatment Planning
Treatment planning requires a prostate ultrasound, also known as a volume study, to measure the size and shape of the prostate. This creates a computerized 3D model, which is used to determine how many radiation seeds need to be inserted in the prostate to eliminate the cancer.
Step 2 – Implant
Your specialists will implant the seeds into the prostate as strands of several seeds linked together. The implant is performed under general or spinal anesthesia and takes about an hour. The urologist then performs a cystoscopy to look inside the bladder to ensure that the seeds are not protruding into the urethra or bladder. The seeds will release low level radiation for 9-12 months to treat the cancer. After a year, the seeds are no longer radioactive and do not have to be removed.
Before: Preparing for the Implant
Prior to your implant, an appointment will be set up, during which your doctor will use an ultrasound to measure your prostate and determine the type (Iodine or Palladium) and number of seeds needed to treat your cancer. Your medical team will work together to generate a plan or “map” for seed placement based on your prostate gland’s volume, shape and tumor location.
The seeds will be delivered to the doctor as close as possible to your procedure time since the radiation within the seeds decays over time. The seeds can be delivered in a variety of forms, depending on your doctor’s preference. The doctor can request loose seeds to load into needles themselves, or they might use a MickTM technique to implant the seeds in a more real-time method. The seeds might also come already inserted into long, thin needles and loaded according to the doctor’s treatment plan.
During: Implant Day
During the procedure, you will be positioned on the operating table with the needle template placed against the perineum. (The perineum is the area between the anus and scrotum.) You will most likely receive general or spinal anesthesia to ensure you feel no discomfort during the procedure. You will not feel the needles going in or the seeds being deposited. The doctor will use an ultrasound to guide the needles through the skin and directly into your prostate gland. Once the seeds are implanted the empty needle is removed.
The small size of the seeds causes no discomfort and allows them to stay in place as dormant titanium shells once their radioactivity has decayed. The implant is a half-day, outpatient procedure with only one to two hours needed for the entire surgery. Following two to three hours for recovery and observation, you will be released.
After: What to Expect
Temporary side effects might include mild discomfort, fatigue, diarrhea, rectal irritation and small amounts of blood and/or sperm in the urine for a few days. You might also experience an increase in urinary tract symptoms, such as frequency, burning and urgency. Other risks may occur but will be discussed prior to your discharge.
You should refrain from strenuous activity and heavy lifting, as well as applying pressure to the area.
Please consult your doctor regarding time frames on restrictions and when you may resume normal activities.