What is prostate seed brachytherapy?
It is estimated that 1 in 9 men will develop prostate cancer during their lifetime. If prostate cancer is detected early, there are several methods of treatment currently available which provide a good chance of a cure. Choosing the treatment option that is best for you should involve obtaining enough information to allow you to understand what each treatment involves.
You should make an informed decision in close consultation and discussion with your doctor.
This procedure involves the insertion of radioactive seeds directly into the prostate gland where they remain. The seeds emit low level radiation for approximately 1 year after implantation. Each seed is 4.5mm in length and 0.8mm wide and resembles a grain of rice, grey in colour.
Benefits of the treatment
- Each seed gives off radiation to a small surrounding area. By careful placement of the seeds, very high doses of radiation can be delivered to areas of the prostate affected by the cancer, and relatively little radiation is received by the normal tissues. These include the rectum which is directly behind the prostate gland, and the bladder which lies on top of the gland. This is the reason why the side effects of brachytherapy are moderate and well-tolerated.
- Convenience - usually as a day case on 2 separate occasions.
Are there any risks?
- You will need 2 short anaesthetics.
- Urinary side effects can be troublesome and prolonged in a small number of men.
At the present time, the results of surgery, radiotherapy and brachytherapy suggest that they are all equally successful in treating prostate cancer. It is important that you understand what is involved in each treatment so you can make an informed choice. All treatment options have a small chance of severe complications which may lead to permanent problems.
What to expect
The procedure has 3 stages. Click on each stage for more information:
Post implant advice
Many people are concerned about whether an implant poses any potential radiation danger to their family and friends. Although the seeds are radioactive, you are not. We will give you a card to carry with you, similar to the one shown. If you are planning to travel through an airport or port in the near future, please ask us for further advice as they may have radiation detectors for security purposes.
One advantage of radioactive iodine-125 seeds is that essentially all radiation is absorbed within the prostate. You will not be radioactive following discharge from the hospital. There are no restrictions on everyday travel or physical contact with other adults. However, you should be cautious when you are in close contact with small children or pregnant women in the first three months following treatment. If your work or hobbies mean you spend long periods of time in close contact with another person, please ask us for advice.
Women who are (or may be) pregnant should not sit very close to you (on the same settee, for example) for prolonged periods for about 3 months. Apart from this, there is no need for you to treat them any differently from how you would have done before the implant. You may greet them as you normally would and they may stay in the same room as you for as long as you wish.
Do not nurse children on your lap or sit very close to them for long periods of time. You may cuddle or hold them for a few minutes each day and they may stay in the same room as you.
The seeds are permanently embedded in the prostate gland but there is a remote chance of a single seed being passed during sexual activity. Patients are therefore advised to use a condom for the first few weeks after the implant. During this, time your semen may be discoloured brown or black. This is normal and is a result of bleeding that may have occurred during the operation and is now being released into the ejaculate. Condoms should be disposed of by double wrapping and placing in the dustbin.
From a practical standpoint, iodine-125 seeds produce radiation for about 1 year. After this time the seeds are virtually inert and remain in the prostate gland, without causing any problem.
The guidance from the International Commission on Radiological Protection (ICRP) recommends that burial, rather than cremation is performed, if death occurs within 2 years of the iodine seed implant.
Follow up schedule
After a seed implant you will see your clinical oncologist and urologist on a regular basis. Both specialist doctors will work together to provide you with the best care possible. The follow-up schedule usually includes a visit every three to six months for the first five years, to check treatment progress. You may have a physical examination and blood tests during these visits.
We will send you an appointment for review 6 weeks after your implant to come to the clinic at The Christie. This visit will include a CT scan which allows us to ensure the quality of our implants remains of a high standard. The scan does not tell us how effective the treatment is. This will be assessed primarily from your PSA blood tests which will be checked regularly. The clinic visit may take up to 2 hours.
Frequently asked questions
Question: I have heard that prostate cancer is slow growing and that some doctors advocate no treatment at all.
Answer: Treatment of prostate cancer presents a dilemma. On the one hand, many patients do not need treatment because their cancer is growing so slowly. On the other hand, prostate cancer is the second most common cause of cancer death in men. With experience, a specialist doctor can reasonably predict how a cancer may behave, but there is no fool proof way to detect how aggressive a cancer will be in any specific patient. This is why most men choose some type of treatment for early stage prostate cancer.
Question: Will I need a blood transfusion during the implant procedure?
Answer: With the ultrasound guided implant, no incision is made - so no blood is needed.
Question: How long after the implant procedure do I have to wait before returning to work or my regular activities?
Answer: Men who have implants are usually ready to return to their regular activity within 3 to 4 days after the procedure.
Question: Will I have hair loss or nausea and vomiting after the implant procedure?
Answer: No. The effects of the implants are highly concentrated and primarily confined to the prostate.
Question: Can I have a radical prostatectomy or external radiotherapy if the seed implant fails?
Answer: A radical prostatectomy or external radiotherapy after seed implant can be hazardous and are rarely recommended. Similarly seed implantation after failure of surgery or external treatment also carries a considerable risk.
If prostate cancer recurs after either brachytherapy, surgery or external radiotherapy, then hormone therapy may be needed. This usually helps to control the disease, but is not a cure for prostate cancer.
Question: Will I be radioactive?
Answer: Although the seeds are radioactive, you yourself are not, because the radiation is absorbed within the prostate gland.
Question: Can the seeds be detected by security alarms at airports etc?
Answer: No, not routinely. The seeds are surgical-grade titanium not a ferrous metal.