Prostate Cancer
Seed Brachytherapy
This leaflet is designed to give you
information about seed brachytherapy
treatment for prostate cancer and what to
expect.
If you have any questions please speak to
your radiation oncologist or the other
helpful staff at William Buckland Radiation
Oncology during your next visit.
More information can also be found on to
the Melbourne Prostate Institute website
www.melbourneprostate.com or in the
booklet Localised Prostate Cancer - A
guide for men and their families.
This booklet explains localised prostate cancer, the treatment options
and their pros and cons. Its purpose is to help men make decisions
about treatment options.
Seed brachytherapy
Brachytherapy is a form of radiotherapy where a radiation source is placed
inside or near the area that requires treatment.
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Seed brachytherapy or low dose rate brachytherapy involves placing small
radioactive seeds permanently into the prostate to administer the
radiation.
The seeds are tiny (0.8 x 4.5mm) sealed titanium capsules containing
radioactive Iodine-125. Once placed inside the prostate they give off a
high dose of radiation. Most of the radiation is given off in the first 12
months.
Although the total radiation dose given to the prostate is high, the rate in
which it is emitted is low. This is the reason seed brachytherapy is called
low dose rate brachytherapy.
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The size of a seed in comparison to a $1 coin
Why use seed brachytherapy to treat prostate cancer?
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Brachytherapy has been used to treat prostate cancer for over a century.
Modern seed brachytherapy utilises sophisticated imaging techniques and
planning computers, new radioactive isotopes and a better understanding of
the pathology of prostate cancer. All of these advances have all led to high
rates of cancer control, and low rates of serious side effects.
Many men prefer the side-effect profile, and the convenience of seed
brachytherapy, compared with major surgery. Men might have other medical
problems that make surgery a non-preferred choice, compared with
radiotherapy.
The prostate cancer cure rates for men treated with seed implants in the last
15 years is the same as the cure rate for men treated with surgical removal
of the prostate over the same period of time.
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Who can have seed brachytherapy?
This treatment is not suitable for all men. There are certain criteria which
need to be met help make the implant a success.
They are:
? Prostate cancer must be confined to the prostate or only spread a few
millimeters from the prostate.
? PSA of 10 ng/mL or less.
? Gleason 7 or less.
? No suggestion of extracapsular disease on physical examination.
Men with very poor urinary flow are not suitable for seed implants because
the urinary flow is affected. If the prostate is very large, a seed implant
may be technically impossible.
How is it planned?
Before we perform the seed implant, we do a volume study. A volume
study is an ultrasound of the prostate which is used to plan your
brachytherapy treatment.
Prior to the volume study you will be given medication to help you relax
during the procedure. This medication will make you drowsy, so you
cannot drive for the rest of the day.
During the volume study you will be positioned in the same way as the
seed implant. An ultrasound probe is positioned in the rectum (back
passage) to get detailed pictures of the prostate gland and the
surrounding anatomy.
The actual volume study will take about 45 minutes, however you will be in
our department for approximately 3 hours.
After the volume study we plan your treatment. We work out how many
seeds are required and depending on the size of the prostate, we use
between 80-120 seeds.
There is usually 6-8 weeks between the volume study and the seed
implant to ensure the seeds will arrive on time from the United States.
The seed implant
The seed implant is done in theatre under general anesthetic. You will be
positioned the same way as the volume study, using a transrectal
ultrasound probe to visualise the prostate.
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Needles, preloaded with your seeds, are inserted into the prostate.
Ultrasound images and x-ray images taken in theatre help us to accurately
position the needles according to your plan.
The seed implant will take about 1 hour. You will either go home on the
day of the procedure or stay overnight.
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Staff in theatre during a seed implant.
After the seed implant
One month after the seed implant you will be required to attend a post
seed implant CT scan at the William Buckland Radiotherapy Centre. This
CT scan is done to ensure the seeds are positioned as expected and the
prostate is receiving sufficient radiation dose.
You will also be required to have a chest and pelvic x-ray, which helps us
to account for all the seeds.
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Side effects
There are some side effects associated with brachtherapy. Below is a list
of the most common side effects associated with seed brachytherapy for
prostate cancer. Side effects may not be limited to the following, so if you
have any concerns please speak to your radiation oncologist.
Side effects can be divided into two groups:
? Acute - Those which happen during or just after treatment.
? Late - Those which happen after treatment is completed.
Acute side effects
Discomfort
? Discomfort in the pelvis and the area between the legs.
? Bruising of the scrotum or penis.
Urinary
? Difficulty passing urine.
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? Blood in urine.
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? Abnormal urine flow - Due to bruising and swelling in the prostate.
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? Frequency - Needing to pass urine more often.
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? Urgency - Needing to pass urine in a hurry.
? Nocturia - Needing to pass urine at night.
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? Occasionally men are unable to pass urine If this happens you will need
a catheter.
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Bowel
? Occasional blood in bowel motions.
? Constipation or diarrhoea.
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Other
? Nausea - The anaesthetic might make you feel sick like you want to vomit.
? Tiredness - Straight after treatment.
? Muscle aches and pains.
? Blood in semen.
? Infections - Are very uncommon and are prevented by the antibiotics
given in theatre and on discharge.
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Late side effects
Urinary
? Urethral stricture - Narrowing of the tube through which the urine flows
out from the bladder. This is uncommon but might require stretching by
a Urologic surgeon.
? Irritable bladder - The bladder is abnormally sensitive to filling, resulting
in the need to pass urine frequently and in a hurry. There can also be
associated penile discomfort. This is very uncommon and can be
helped with simple medication.
? Urinary leak or incontinence - Is very uncommon and usually associated
with irritable bladder.
Bowel
? Serious bowel problems are very uncommon but may increase the
frequency and urgency of bowel motions and/or cause mucous or blood
to be mixed with bowel motions.
? Rectal ulceration - very rare.
? Rectal fistulas - very uncommon.
Sexual
? Impotence - There may be a period after the brachytherapy and external
beam radiotherapy when men are temporarily impotent. It is thought in
general terms, that of men who are fully potent prior to treatment, 60 70% will regain and maintain this.
? Discomfort with ejaculation.
? Decreased volume of ejaculate - is common.
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Prostate Cancer - Seed Brachytherapy
WBRO Patient Information Committee 2013. Prostate Cancer - Seed Brachytherapy.
Victoria: William Buckland Radiation Oncology.
This edition November 2013
55 Commercial Rd
Melbourne, Victoria 3004
Telephone
+ 61 3 9076 2337
Facsimile
+ 61 3 9076 2916
P.O. Box 424
Traralgon, Victoria 3844
Telephone
+ 61 3 5173 8770
Facsimile
+ 61 3 5173 8473
www.wbrc.org.au
www.lrh.com.au
WBRO Patient Information by William Buckland Radiation Oncology is licensed under
a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License
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First Published November 2013