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Patient Information For High Dose Rate Hdr Prostate Brachytherapy

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Seed Brachytherapy

Assessment of your eligibility is important for any treatment option. Not all men with early prostate cancer are suitable for brachytherapy.

It is only appropriate for men who have low risk, early stage disease. There are strict Medicare guidelines with respect to reimbursement eligibility. Patients who have previously had a transurethral prostatic resection (TURP) are not eligible for the procedure because complication rates are increased. There are several other factors that may affect your suitability for prostate brachytherapy.

The Prostate Cancer Institute has developed specific guidelines for deciding if you are eligible. During the clinic, an experienced specialist will examine you, and all aspects of your medical history and disease will be thoroughly reviewed and documented. At the end of your visit you will be informed of your eligibility for prostate brachytherapy.

It is not the intention of the Prostate Cancer Institute to promote Seed Brachytherapy or to suggest that it is the best treatment for all suitable patients.

If you are suitable for Seed Brachytherapy, you and your partner/family will have to decide if it is the right treatment for you.

In order to make this decision you need to be well informed of your other treatment options, which may be equally suitable for you. These may include watchful waiting, primary hormone therapy, conventional radiation therapy or surgery.

•  Ultrasound Measurement of the Prostate (Volume study)

Many of you will have had an ultrasound of the prostate performed at the same time that you had your prostate biopsies.

A detailed series of measurements will be made to determine the size and shape (volume) of your prostate. This is done for two reasons.

First, since each individual is different, the Medical Physicist and the Radiation Oncologist use this 'volume study' to plan your treatment - to determine the number of radioactive seeds required and where each seed should be placed.
Secondly, the prostate must be within a certain size to be implanted. If your prostate is too large for immediate Seed Brachytherapy, the Radiation Oncologist may recommend hormone therapy for a few months to reduce the size of the prostate. A repeat ultrasound will be then be done to see if adequate shrinkage has occurred making Seed Brachytherapy feasible.

Implant Procedure

This procedure involves the insertion of radioactive Iodine capsules (called seeds) directly into your prostate gland. A general anaesthetic is given. These seeds will not be removed, but will lose their radioactivity over time. Once the implant has been completed, you will be sent home that day or the following morning. The radiation from the seeds will be delivered to your prostate over the next several months.

Because the radiation levels outside your pelvic area will be very low, there are only a few minor restrictions regarding contact with others.

Components of a seed implant

Possible side effects:

•  Slight bleeding, bruising and tenderness between the legs are common. If bleeding persists beyond 24 hours after your implant, you should contact your oncologist/ urologist.
•  Burning on urination, urinating more frequently, mild pain or feeling unable to pass urine freely are common, and should stop in one to four months after your implant. (It may be easier to empty your bladder by sitting down on the toilet seat, rather than standing up).
•  Rectal discomfort is rare.
•  Ejaculations may be uncomfortable and discoloured dark brown, black or red. This is normal, and is a result of blood that can be released into the semen during and after the implant. (Also see Radiation Safety Concerns)
•  In 5-10 % of the patients, a temporary complete blockage of urination occurs. If you have not urinated within 12 hours of your implant procedure, and are having bladder fullness and discomfort, you will need to call your oncologist/urologist, or go to the Emergency Department at the nearest hospital to have a catheter placed in the bladder. If you need to go to the Emergency Department, you must inform the staff that you have had a radioactive seed implant, and under no circumstances should you have a Transurethral Resection of the Prostate (TURP transurethral prostatic resection of the prostate) to help you pass the water. The catheter may stay in for few days or few weeks.
•  If you have any concerns with the side effects that you may experience after the implant, please phone your Oncologist, your medications may be adjusted to help these symptoms.

Late side effects:
•  There is a small risk of developing a urinary stricture or narrowing of the urethra that may make it difficult to pass urine. Your urologist can usually treat this.
•  There is a very small risk of causing urinary incontinence (<1%).
•  Sexual Function: The chance of sexual function declining varies with each patient. This should be discussed with your oncologist/urologist
•  There is a small risk of causing an area of ulceration of the rectum (<1-2%).

Avoid any heavy lifting or strenuous physical activity for the first week following an implant.

Radiation safety issues:
Brachytherapy for prostate cancer and cremation: radiation safety concerns
The radioactive implant you are considering consists of a number of small metal capsules each containing a measured amount of a radioactive form of Iodine known as Iodine 125. Each capsule is sealed to prevent any loss of the radioactive Iodine. When sealed within the capsule, the radioactive Iodine is not a health hazard. The capsules are very strong, but they can be destroyed by extremely high temperatures such as occur during cremation.
Cremation of a body containing an implant like the one you are considering could result in the release of radioactive Iodine. Releasing radioactive Iodine in this manner could be hazardous to people who might be exposed such as funeral home workers.
For this reason, should death occur for any reason within one month of receiving the prostate implant, your body must not be cremated. It is important that both you and your family understand this restriction. If this restriction is in conflict with your religious/cultural beliefs or is contrary to the instructions that may exist in your Last Will and Testament, you must inform your oncologist at least 3-4 weeks before the implant.

Radiation Safety Precautions:
The seeds that will be used for your implant are low energy radioactive materials that lose their strength over time. The low energy of the seeds means that the most of the radiation is contained inside the prostate gland. A small amount of radiation is given off to the area of the body nearby such as the rectum & bladder.
Objects that you touch, or come in contact with, DO NOT become radioactive. Your bodily wastes, (urine and stool) are NOT radioactive either. Occasionally, seeds enter the bladder after the implant and may be passed into the urine. This will usually occur within a few days after the implant. A lead pot and strainer is used for the first week after the implant to strain your urine.
There is a rare chance to have one or two seeds travel through the blood stream to the lung (1%). They would stay in the lung permanently. So far we have not recorded any problems related to this.

Radiation safety precautions following the implant:
•  Any pregnant or possibly pregnant woman should avoid prolonged close contact with you for the first 3-4 months after your implant. As long as she stays a distance of 1.2 metres or more away, there is no limit to the amount of time she can spend with you.
•  Small children should not sit on your lap, but can sit next to you with no time limit.
•  You may sleep in the same bed as your partner, provided that person is not pregnant. Sexual activity may be resumed whenever you feel comfortable, (usually within a week), after the implant
•  Rarely a seed may be released into the semen during your first ejaculations after implant. Hence a condom should be used with the first ejaculations
•  The seeds will eventually lose their radioactivity (~ 90% of the radioactivity has dissipated over first 6 months).

Questions to ask your Radiation Oncologist

Implant probe used in seed brachytherapy