PROSTATE SEED FREQUENTLY ASKED QUESTIONS

1. Where did radioactive seed implants originate?

The procedure was pioneered at the Memorial Sloan-Kettering Cancer Institute in New York more than 20 years ago. However, because advanced ultrasound technology was not available, abdominal surgery and hand placement of the seeds were utilized. This method was not consistently successful, and was discontinued. Advances in ultrasound technology several years ago now allow physicians to create a map of the prostate and determine the exact number of seeds -- usually between 40 and 100 -- to be implanted.

2. What does the treatment involve?

After spinal or general anesthesia, an ultrasound probe is positioned in the rectum to allow for proper needle alignment. A template guidance device, which is attached to an ultrasound probe, has holes that correspond to a grid on the ultrasound computer screen. Implant needles are put through the appropriate template holes. These needles may be preloaded with the seeds or may attach to an applicator that dispenses the radioactive seeds through the needles and into the prostate. Each needle is guided through the template, then through the perineum (the area between the rectum and scrotum) to its predetermined position. The ultrasound unit's screen allows the physician to see the needle's exact position in the prostate. A predetermined number of seeds are then implanted. When all seeds have been inserted, the ultrasound image is again reviewed to verify seed placement.

3. What are possible complications?

Bruising or swelling between the legs may occur, but usually disappears in a few days. Urinary discomfort -- a sense of urgency, burning during urination, slight bleeding or blood in the urine -- is to be expected but will diminish as the seeds lose their radioactivity within several months. Rectal irritation and occasional rectal bleeding may occur, but should subside in less than three months. Drinking plenty of fluids and avoiding caffeine may help relieve the urination symptoms. Most of the time you will not experience severe pain. However, you might be uncomfortable. You may be given sleeping pills or other medication to relax you. You may have some erection problems immediately following the treatment, but a large percentage of men who have had this treatment report they are still able to have erections, although they may not be as firm as they were before the treatment.

4. What happens to the seeds?

The seeds, which are made of radioactive iodine, iridium or palladium, eventually lose their potency within a year, but remain in the prostate forever, causing no problems. Because the seeds are imbedded in the prostate gland, they cannot be passed to another person through sexual activity.

5. How long after the treatment will I be able to resume normal activities?

Usually, you can go back to work and to your normal activities such as exercising or walking within a few days. You should wait four to six weeks before resuming sexual activities.

6. What type of follow-up is needed?

Follow-up with your urologist and radiation oncologist should be done regularly -- usually every three to six months for the first five years -- to check seed placement and treatment progress. Physical examinations, blood tests and transrectal ultrasound (TRUS) examinations will be performed periodically.


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Radioactive seeds, shown here in comparison to a dime, are smaller than grains of rice.




CAT scan of a prostate after radioactive seed implantation


Anterior radiograph showing a well-placed seed


Lateral view of same patient