Transperineal Prostate Implant
Today, several forms of treatment for cancer of the prostate are available. This page is intended to discuss the Radioactive Seed Implant as a treatment option. It will explain in detail what you may expect from this treatment, and what precautions are necessary as a result of the treatment.
The Prostate Gland
The prostate gland is located at the base of the penis just below the bladder in front of the rectum. It produces the fluid that transports semen during ejaculation. The size and shape of the prostate gland vary considerably, but it is usually about 3-5 centimeters in diameter (about 1-2 inches).
Cancer of the Prostate
Cancer of the prostate, like other cancers, is a disease of the body's cells. All cells reproduce themselves by dividing. Normal growth and repair of tissue takes place in an orderly manner. Cancer is abnormal, disorderly and unrestrictive growth which invades and destroys nearby tissues and organs. It may also spread to other parts of the body. Cancer may arise in any part of the prostate gland, but is most commonly found in the outer portions. It is more common in older men. Its cause is unknown.
How Does Radiation Treat Cancer?
In order to kill the cancer, your physician places (implants) radioactive "seeds" into your prostate gland. These radioactive seeds (either Iodine-125 or Palladium-103) give low energey X-rays which are just right for destroying the cancer in the prostate but do not cause damage to the rest of the body, but could effect surrounding organs. Iodine-125 (abbreviated I-125) and Palladium-103 (abbreviated Pd-103) give up about 90% of their radioactivity within two-six months. By one year, the radioactivity can be considered miniscule. The radioactive seeds are about the size of a grain or rice. The physician will place about 50-100 of the seeds into your prostate gland. The exact number depends on the size of your prostate gland and other considerations. Even though the cancer may be present in only a portion of your prostate gland, there may be microscopic amounts of cancer throughout your gland. For this reason, the entire gland is treated.
Planning for the Implant
Before the implant procedure, your radiation oncologist, urologist, or radiologist will perform an ultrasound study to determine the size of your prostate gland. This is called a volume study. A radiation physicist will order, receive and assay the appropriate number of seeds and activity using the volume study data.
What Preparation is Required before the Procedure?
Approximately one week prior to the implant, you will have blood tests done and possibly an electrocardiogram (EKG) and chest x-ray. Your doctor will determine which tests are necessary. The test results are used to inform the anesthesiologist of your ability to tolerate anesthesia. Typically, you will be admitted to the hospital the same day as the implant. You will be given specific instructions regarding some diet changes and use of enemas required one to two days before the implant. The enemas will help move fecal material out of your lower bowel and rectum so that the ultrasound pictures of your prostate will be clear. At midnight on the night before your implant, you will not be allowed to eat or drink anything until after the procedures.
How is the Implant Done?
The radioactive seed implant procedure lasts about two to three hours. It is done in the operating room. You will receive medication through an intravenous (IV) line which will make you drowsy. You may receive spinal anesthesia, leaving you numb from the waist down. Many patients may have general anesthesia. Before the seeds have been implanted, a catheter will be placed temporarily in your bladder to drain urine. The implant procedure is not an operation requiring a surgical incision. Instead, a small, round ultrasound probe is placed in your rectum. The probe gives a picture of your prostate gland on a screen. Needles are passed through the skin between the rectum and scrotum, and are guided into the correct position in your prostate, as viewed on the screen. The seeds are then passed into the prostate through the needles. Both the probe and the needles are removed when the procedure is completed leaving the seeds behind.
What Happens Afterward?
After the implant, you will go to the recovery room for about two hours, until you are more fully awaken from the anesthesia and have regained feeling down to your hip level. While in the recovery room, you may have an ice bag placed between your legs to help reduce swelling of the implant area. The urinary catheter will be removed before you are discharged from the hospital, usually the next day. There is very little discomfort after the implant. If you do feel discomfort, pain medication will be available to you. Your urine may contain blood. This is normal and should subside after a few days. If blood persists or if you begin to pass blood clots, you should contact your doctor. Once you have regained full feeling in your legs, you may get up and walk. Initially, you should do this with your nurse's assistance. You may feel a little lightheaded when you first get up. This should pass quickly. You may have visitors in your room during hospital visiting hours. Limitations regarding exposure to pregnant women and small children are explained in detail under Radiation Safety. You most likely will return home the same day or the following morning. You should avoid heavy lifting or strenous physical activity for the first two days once you are home. After that, you may return to your normal activity level.
Radiation Safety
Radiation safety is a concern of many of our patients. I-125 and Pd-103 are radioactive materials that emit radiation of low energy. The low energy of the seeds means that their radiation only travels a short distance. Most of the radiation is contained within the prostate gland. However, some amount of radiation is given off to structures very close to the prostate, such as the rectum. A very small amount is present outside the body. There are precautions that we ask you to take to ensure that those around you are protected from unnecessary radiation. Objects that you touch or items that you use do not become radioactive. Your bodily wastes (urine and stools) are not radioactive.
Precautions
Any pregnant woman should avoid prolonged close physical contact with you for the first three months after the implant. A momentary hug and embrace is quite acceptable. However, she should then move to a distance of about six feet or more away. At a six-foot distance, there is no limit to the length of time she can be in the same room. Children should not be allowed to sit on your lap during the first three months following the implant. Sexual intercourse with a condom may be resumed two weeks after the implant. The first few times that you have sexual relations you may experience some pain at the time of orgasm. Your sperm may be discolored dark brown to black. This is normal and is a result of bleeding that may have occured during the implant and is now being released into the ejaculate. After two months, it will not be necessary to use a condom. To avoid the possible close contact with your spouse that may occur for several hours at night, we recommend that for two months you either sleep alone or if you have a large bed you may consider placing a physical object to keep you separated. For two weeks after the implant procedure, it is possible that you could lose seeds through urination, or in the ejaculate following sexual intercourse.
Are There Any Side Effects From the Procedure?
There are a few side effects that you can expect following the procedure such as: weaker urinary stream, increased voiding frequency during the day and night. You may experience some burning or discomfort during urination. You can expect these symptoms to last for a few months. If they become severe contact your physician. Antibiotics are given after the implant to prevent infection. You should take the antibiotic as prescribed by your physician until the prescription runs out. If you develp a allergic reaction, such as skin rash, stop the medication and contact your physician.
What about follow-up?
Three to four weeks after the implant, you will be asked to return to the Medical Center for a brief exam and X-rays. The X-rays will enable the physicians to count the exact number of seeds left in the prostate and document their position. A CT scan may also be requested. X-rays may be taken the day after the implant prior to discharge. Follow up with your urologist and radiation oncologist will be done on a regular basis, usually every three months. Physical examination, blood tests and rectal ultrasound tests will be done at certain intervals as part of your follow up visit.
A Final Word
While prostate cancer is very common, each of our patients are unique. Your treatment decision can only be made after a thorough discussion with your physicians about your specific situation. Whenever you have questions, make sure to ask your doctors to discuss these concerns with you.
