Prostate Brachytherapy
Radioactive Seed Implantation for Prostate Cancer

Introduction
Prostate cancer can be successfully treated with tiny radioactive seeds which emit radiation that destroys cancerous cells. Accurate placement of seeds ensures that the prostate receives the necessary dose of radiation while minimizing its effects on healthy tissue surrounding the prostate. The overall cure rate for prostate seed implantation is comparable to radical prostatectomy and external beam radiation therapy. In addition to many advatages, side effects with this treatment are minimal, and the chances of developing impotence or incontinence are low.

This procedure is performed by a team of urologists and radiation oncologists at Good Samaritan Hospital. The radiation oncologists have a combined experience of several hundred seed implant procedures.

Questions and Answers
What side effects can I expect from this procedure?
You may notice blood in your urine for one to two days following the procedure. Placing the needles and seeds in the prostate gland during surgery causes the prostate gland to swell. You may experience discomfort or burning with urination, as well as frequency or urgency for a few weeks. Medication can be prescribed to help minimize these side effects. Some men may have trouble urinating. Drink plenty of fluids, avoid caffeine, and contact your urologist if difficulty persists.

You may notice some tenderness, bruising, or discomfort in the scrotal area for a few days following the procedure. Exertion, such as heavy lifting, may cause bleeding into the prostate and swelling. Exertional activities should be avoided during the first month. Moderate activities such as walking, swimming, and golfing should not cause any difficulties.

How safe is radiation therapy?
The radioactive seeds emit a low level of radiation that is primarily confined deep in the pelvis. Over approximately two months the radiation levels decrease until they are no longer detectable. Objects that you touch are not radioactive; your urine and stool is also not radioactive. Any woman who is or may be pregnant should avoid prolonged close contact with you for two months following the procedure. This means she should not hug you or sit close to you. She can greet you briefly and then move six feet or more away. At six feet there is no limit to the length of time she can be in the same room with you. Children should not be allowed to sit on your lap during the first two months following the implant. Sexual intercourse with a condom may be resumed two weeks after the implant. The radiation oncologist or the medical physicist can address any concerns you may have regarding radiation safety.

Who can receive radioactive seed implantation for prostate cancer?
Your physician will consider your age, PSA level, the size of your prostate, how aggressively the cancer is growing, the stage of your cancer, and your overall medical condition to determine if radioactive seed implantation is an appropriate treatment for you. Most men with early stage prostate cancer are excellent candidates for this treatment. If prostate cancer has spread beyond the prostate alternative treatments may need to be considered.

I have heard that prostate seed implants were used years ago and were ineffective. Is this true?
The early results from radioactive prostate seed implants showed that it was not as effective as external beam radiation therapy and resulted in more complications. Physicians experienced difficulty in placing the seeds accurately, and some areas of the prostate did not receive adequate radiation. Currently, transrectal ultrasound and improved treatment planning techniques allow for precise placement of radioactive seeds and thorough treatment of the prostate.

What other types of treatment for prostate cancer are available?
Surgery to remove the prostate (radical prostatectomy), external beam radiation therapy, and hormonal treatments are other options for treating prostate cancer. Cryosurgery is freezing the prostate to destroy the cancer cells. Its use is limited because the bladder and rectum restrict the extent of freezing, and it is difficult to treat the entire prostate adequately. In the past chemotherapy has not shown significant benefit in treating prostate cancer, although new medications and treatment combinations are under investigation. Observation has at times been suggested, especially if the person has more serious medical problems and is in poor health. You should speak to your physician regarding what is your most appropriate treatment option.