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.