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1 !$01"%$%&'2-+*%$' 345 ' 6$$+'217/"%&"#-%',0"89:&9$0"7:!"#$%&'()*+$',--./$& Mr Stephen Lindsay Bendig >>>C"%+0$>B$$C8-1C")

2 !""#$%&'()*+),-*$./)012+1"/)'2!"#$%&'(#)%" Du have been given this bklet because it appears yu may be suitable fr a prstate radiactive seed implant prcedure. Mdern day prstate seed implants have been perfrmed since the mid 1980 s and have becme a widely accepted means t treat sme men with prstate cancer. This prcedure is a multi-step prcess perfrmed ver several weeks. Understanding each step f the seed implant prcedure will make yu mre cmfrtable and cnfident in yur treatment. This bklet was designed t prvide yu with general infrmatin abut the seed implant prcess. Each majr step is described, prviding specific infrmatin that can be reviewed at yur cnvenience. Yu can preview each upcming step f the prcess as it appraches withut wrrying abut understanding the entire prcess at nce. Always remember t bring this bklet with yu t any implant related appintment. This infrmatin will als be yur surce t help maximize yur understanding, cmfrt and cnvenience regarding the seed implant prcess. The material in this bklet was prepared by brachytherapy practitiners, hwever, it is meant t be infrmatinal nly and shuld nly be used in cnjunctin with medical advice frm yur treating dctrs *+&)%+(#),-./--&.!012+"#+#)%" Radiactive seed implantatin is a ptentially curative treatment fr early lcalised prstate cancer. At present it is recmmended fr cancers f Gleasn scre 7, PSA less than r equal t 10 and in men with relatively small prstates wh have gd urinary flw. The treatment invlves injecting between 80 and 100 tiny seeds int the prstate thrugh the perineum. The perineum is the skin beneath the scrtum and abve the anal canal. Each seed is rughly the size f an un-cked grain f rice. The seed s sit in the prstate but are nly radiactive fr between three and fur mnths. It is during this time that the cancer is killed. The advantages f seed brachytherapy include that the prcedure is minimally invasive nt requiring a surgical incisin. As a result yur recvery is very quick with men returning t wrk 3 t 4 days after the prcedure.!"#$%&$'() Numerus studies have shwn that cure rates with seed brachytherapy are equivalent t surgery and external radiatin Seed implantatin takes 30 t 45 minutes t perfrm and requires a ne night hspital stay Incntinence is extremely rare Imptence rates are the vicinity f 20 t 30% E *+)$"#$%&$'() Between 1 and 6 mnths fllwing implantatin it is cmmn t experience the need t pass urine mre frequently and yur urinary flw may reduce. This ccurs because there is a lt f swelling f prstate. In sme men (less than 5%) it may be necessary t insert a temprary catheter int the bladder. Smetimes yu will be recmmended t take certain prescribed medicatins fr the first few mnths after the implant t minimise flw prblems. Althugh there are n regulatry requirements t islate yu after implantatin, we d advise that fr tw mnths after the implantatin yu minimise cntact with children under the age f three and pregnant wmen. Any prstate surgery fllwing seed brachytherapy can be assciated with increased risk. Page 1

3 34-.5%2'0-./#'&6 Apprximately ne mnth befre yur implantatin, a vlume study will be scheduled. A vlume study invlves acquiring multiple pictures f yur prstate using a transrectal ultrasund device placed in yur rectum. This is dne because n tw prstates are ever the same in terms f their size and shape It is therefre necessary t individualise the radiatin plan t yur particular anatmy and the Vlume Study allws the necessary infrmatin t be cllected in rder t achieve this unique plan. The vlume study can be dne under either a lcal anaesthetic r a 15 minute general anaesthetic. At the same time, yur dctr will perfrm a cystscpy which invlves placing a small telescpe in thrugh the eye f the penis t internally inspect yur bladder and prstate. Occasinally at the time f vlume study certain prblems may be discvered that may prve t make seed brachytherapy technically challenging. One f these prblems may be that yur prstate gland is t big. If yur prstate gland is t big yur dctr may recmmend that yu take hrmne tablets r injectins fr three mnths in rder t shrink yur prstate. If this is the case then the vlume study usually needs t be repeated at a later date. 34-.)012+"#.1$%(-&'$-,-.(/012(1$2$&+-%03(4-2( /$%&80 '6+"(/+%() 9:($&2(80;71/$%&012-<("62( A typical see implantatin takes between 30 and 45 minutes t perfrm. It is perfrmed either under a lcal anaesthetic with sedatin r a general anaesthetic. The prcedure is perfrmed by a urlgist and radiatin nclgist. Other members f the implant team include radiatin physicists, therapists and specially trained nurses. An ultrasund prbe will be inserted int the rectum t identify the prstate. The seeds are then directly injected int the prstate and guided int place using the ultrasund pictures. Between 20 and 30 needles are used t inject the seeds. At the end f the prcedure a cystscpy is perfrmed t cnfirm that seeds are in the crrect psitin. A urinary catheter is temprarily placed in yur bladder t drain urine and will be remved the next mrning. Read the fllwing recmmendatins carefully =:$&0:$11(%)0$4&( /$%&> Begin a lw residue diet three days befre yur implant (See sectin n special diet cnsideratins) Change t a clear liquid diet arund lunchtime the day befre yur implant D nt have anything t eat r drink frm midnight the night befre yur implant Administer a Micrlax enema between 8 PM and bedtime the night prir t yur implant Administer a secnd Micrlax enema upn waking n the mrning f yur implant Micrlax enemas can be purchased frm yur lcal pharmacy withut the need fr a prescriptin After the implant yu will g t a recvery rm fr abut tw hurs. While in the recvery rm a bag f ice will be placed between yur legs t help reduce t swelling f the implant area. The urinary catheter is usual remved the next day. Mst patients g hme the day after the prcedure but sme may leave hspital as sn as they have recvered frm the anaesthetic and are able t pass urine freely. Because yu may feel weak and yur alertness and judgement may be affected by the anaesthetic, yu must nt drive fr at least 12 hurs. Yu may resume eating and have visitrs as sn as yu wish, but yu shuld avid heavy lifting r strenuus physical activity fr the first 3 t 4 days after the peratin. Page 2

4 !""#$%&'()*+),-*$./)012+1"/)'2 7%88)92-.8)&-.-::-(#8.:%22%;)"<.6%'$.1$%(-&'$-.+"&.+(#)%"8.#%.#+=-,/--"0+%0?2+%( Sme pinkish clur r bld in yur urine is cmmn fr a few days fllwing yur implant. Increase yur fluid intake t flush any bld frm yur urine. Water is the Frequent urinatin, burning and dribbling cmmnly ccurred days after the yur implant. Wearing a pad may prtect yur undergarments. Frequent urinatin may cntinue fr several weeks t a few mnths. Symptms are mst trublesme frm ne t 3 mnths after the implant. Please see guidelines t bladder care fr further advice,/-<b$'( Rarely, a patient will be unable t urinate wing t swelling r blckage f the urethra. If yu cannt urinate, a small sft bladder catheter will be inserted t drain yur urine. The tube can be attached t a leg bag which yu will need t wear. If yu cannt pass urine and have a painful bladder yu will need urgent medical attentin. Call yur specialist r present t an emergency department,26+)+%' Sme bruising, discluratin and swelling f the perineum and testicular area can ccur. It is als cmmn t have bruising in the area f the implant r a feeling f fullness when yu sit. It will last abut 3 t 4 weeks and then reslves n its wn. It requires n specific treatment. Applying an ice pack can help increase cmfrt. C$+% Mild t mderate pain at the implant site may ccur. Panadeine will relieve mst f the pain. A prescriptin fr Panadeine Frte may be given fr severe pain. If yu are cncerned by severe pain cntact yur specialist. ;%4(<&+-% The risk f infectin fllwing brachytherapy is very lw. Yur anaesthetist will give yu an intravenus injectin f an antibitic at the time f yur anaesthetic. In additin, yu will be given a prescriptin fr antibitics t prevent infectin. Take the pills as prescribed until they are finished. D(E6$/0$<&+#+&5 Bld in the semen may ccur fllwing the prcedure and last fr several ejaculates. Althugh it is quite safe fr yu and yur partner t resume nrmal sexual activity fllwing the implant, it is recmmended t initially use a cndm. F-))0-40(G$<6/$&-250#-/67( Fllwing yur implant, men can develp a dry ejaculate. Very ften this is due t semen being passed int yur bladder rather than ut thrugh yur penis during climax. The seminal fluid is later passed ut thrugh yur urine when yu next int yur bladder *+$22:-($ Yu may experience sme diarrhea r lse bwel mtins. If this happens, the bland residue diet will be useful t cntrl yur symptms. Prducts like Metamucil can be used t firm up bwel mtins. Discuss this with yur dctr Page 3

5 *+&)+#)%".8+:-#6 Radiatin safety is a cncern fr many patients and their families. Idine 125 is a lw energy radiactive material that lses its radiactivity quickly. The lw energy f the seeds means that mst f the radiatin is cntained within the prstate gland. Sme radiatin is given ff t the surrunding structures such as the rectum and bladder. Yur bdy fluids are nt radiactive and bjects that yu tuch d nt becme radiactive. Only a very small amunt f radiatin escapes the bdy. Yu shuld bserve precautins t ensure that thse arund yu are prtected frm unnecessary expsure. Occasinally seeds end up in the bladder after the implant and are passed in the urine. this it will usually ccur within ne t tw day f the implant. The lss f a few seeds will nrmally nt affect yur treatment. Befre yu leave hspital, yu will be given a seed recvery kit cntaining a cntainer, tweezers and lead puch. If yu d pass a seed after discharge d nt pick them up with yur fingers. Use the tweezers t place them in the prvided cntainer. It is a regulatin that all men wh have a seed implant carry a credit card sized alert in their wallet. Yu will be given ne f these befre yu are discharged frm hspital. In case f a medical emergency whereby yu are taken t a hspital fr unexpected treatment (i.e. car accident etc.) then yur card will advise the treating dctrs f yur recent seat implant C2(<$6&+-%) Any pregnant r pssibly pregnant wman shuld avid prlnged persnal cntact with yu fr at least the first tw mnths fllwing yur implant. She can greet yu briefly and then mve t a distance f 6 feet r mre away (tw steps away). At this distance (tw steps) there is nrmally n limit t the length f time she can be in the same rm with yu. Yung children under the age f three shuld nt be allwed t sit n yur lap fr at least the first tw mnths fllwing the implant. Hwever they can sit next t yu with n time limit. Yu may sleep in the same bed as yur partner. The use f a cndm is recmmended fr the first 2 t 3 ejaculates due t the very lw risk f a seed being passed in the sperm. Yur semen can ccasinally be bld stained and climax can smetimes be uncmfrtable. While sexual intercurse is nt harmful with these first few ejaculates, the symptms may be undesirable fr yu and yur partner. >%22%;?'1.8(4-&'2- Either ne day r ne mnth fllwing yur surgery yu will be asked t underg a CAT scan and a Chest X-ray. The CAT scan will enable the dctrs t determine the exact psitin f each seed in the prstate. This is necessary t determine that yur prstate is receiving the prper amunt f radiatin. A Chest X-ray is als perfrmed t determine if any seeds have travelled t the lungs. Seeds in the lung are uncmmn but if it des ccur n specific treatment is required and n harm is dne. Yu will see yur urlgist and radiatin nclgist n a regular basis. Bth specialist dctrs will wrk tgether t prvide yu with the best care pssible. The fllw-up schedule usually includes a visit every 3 t 6 mnths fr the first five years t check yur treatment prgress Page 4

6 !""#$%&'()*+),-*$./)012+1"/)'2 /'<<-8#-&.<')&-2)"-8.#%.92+&&-$.(+$-.:%22%;)"<.6%'$.8--&.)012+"# A regular healthy diet is recmmended unless yu are n a special diet fr ther reasns. Drink plenty f fluids, at least 2 L each day, t keep yur urine dilute. Minimise yur intake f alchl, tea, cffee, cla and chclate-based drinks. Chse a range f ther fluids. After yur implant, it is nrmal t experience sme difficulty with yur urinatin. Pssible side effects include red urine, urinary frequency and blckage. Yur dctr may prescribe ne r mre medicatins t imprve r lessen yur letter symptms as listed belw. 92+7(&:-12+70HII7'0-20J-24/-E$<+%0KII7' Bth f these drugs are antibitics and may be prescribed by yur dctr t cmmence ne day befre yur implant. Yu will als leave hspital with a five-day supply fr which yu will need t take until yu have finished. J$12-E(%0D-"+670LMII7'N This is an anti-inflammatry drug usually given fr arthritis symptms and has been used t relieve sme f the symptms f prstate swelling after yur implant. It is an ver-the-cunter drug s, s yu can buy it withut a prescriptin at the These medicatins relax the muscles f the urethra and bladder, allwing fr imprved stream and emptying f yur bladder. Yu may be given a script fr ne f these medicatins and be tld t cmmence it apprximately ne week befre yur implant. If yu re urinary flw is cnsidered t be satisfactry, smetimes yur dctr wn t start these tablets until after the implant and if yu are experiencing urinary flw disturbance. These medicatins are generally well tlerated, but a small percentage f patients can becme lightheaded r experience fainting. If light-headedness r dizziness ccur, sit r lie dwn immediately until a sensatin ges away. Ntify yur dctr and nurse f any prblems. Yu shuld nt run ut f these medicatins and ask fr mre supplies frm yur lcal dctr r specialist dctr. C$%$"-/0O0C$%$"(+%( These are ver-the-cunter medicatins. The usual dse is tw pills every 3 t 4 hurs as required. Use is directed t relieve pain and als t help yu sleep. These may be taken with naprxen. C$%$"(+%(0@-2&( This is a prescriptin medicatin fr mderate t severe pain. The usual dse is ne t tw tablets every 3 t 4 hurs as required. Users directed t relieve pst implant pain. Nte that the Panadeine Frte may cause cnstipatin. This drug may als be taken with Naprxen. Page 5

7 F-.0T()+"6(0*+(& Belw is a suggested guideline fr the bland mdified diet which yu will be asked t cmmence 3 days befre yur implant. Nte that yu have several fd items in each categry frm which t chse, making this temprary diet easy t fllw and simplifying meal planning/ This diet has been designed by dieticians. Be assured that this diet ill satisfy yur daily nutritinal needs during this limited perid, but if yu wuld like yu may supplement yur diet with a high quality multivitamin. Meat, Fish, Pultry, Eggs Suitable Fds Tender lean red r white meats trim ff visible fat. Pultry, remve skin Fish, shellfish and fish tinned in water rather than il Eggs, Lean bacn, ham & crned beef Fds t Avid Tugh gristly r fatty meat. Highly seasned meats such as curries. Avid fried meats and the uter crust f rast meat Mild and Milk Prducts Suitable Fds Fds t Avid Milk, frtified milk. Milk prducts such as icecream, ygurt r cheese cntaining Cheeses, chse lwer fat varieties such as cttage r rictta fruit skins, seeds and nuts Yghurt & icecream (nt cntaining fruit skin r seeds) Vegetables Suitable Fds Fds t Avid Sft cked and peeled vegetables. Vegetables seeds and skins. Onins, garlic, leeks, cabbage, Carrts, parsnips, ptates, pumpkin, marrw, peeled and brussel spruts, turnips, peas, whle tmat, radishes, lives, seeded tmat and zucchini, flwer f brccli and cauliflwer, cucumber, sweetcrn, peppers. bradbeans, dried beans, baked beetrt, mushrms, silverbeet, green r French beans, tender beans, split peas, legumes, Pickled vegetables. lettuce, asparagus tips, celery with uter fibres remved Fruit Suitable Fds Sft stewed r canned fruits withut tugh skins r seeds. Ripe apple, pear, banana, watermeln, cantalupe, cherries, peaches, apricts and ther stne fruits are suitable. Juices apple, blackcurrant, pineapple, peach, aprict, grape, tmat, guava and berry juices are suitable (limit t 2 glasses per day and dilute with water Bread, Cake, Biscuits Suitable Fds White r fine whlemeal r rye bread, tast, plain scnes r buns. Plain cake and biscuits, eg. Plain spnge cake, Milk Arrwrt biscuits, Salada r Sa biscuits U/($20/+A6+"0"+(&0'6+"(/+%() Fds t Avid Rhubarb, pineapple, figs, strawberries and berry fruits, grapes, grapefruit, mandarins, ranges. Fruit skins, lemn peel r seeds. Dried fruit and nuts eg. Sultanas, raisins. Orange grapefruit and ther citrus juices shuld be taken in mderate amunts nly Fds t Avid Carse whlegrain r cracked wheat breads, bread r rlls with pppy, sesame seeds r caraway seeds. Biscuits r cake cntaining whlegrains r seeds, nuts, ccnut dried fruit r spices F9$B$'A)*+$/*%$B'G-0'"'8/$"0'/*H)*+'+*$&'"0$'&-';$')B$+'FIJ'<=D',JK@?J'D@L?'2M!N=OF6$/$8&'*&$1B'G0-1'&9$'/*B&' ;$/->P'<-'%-&'$"&'-&9$0'G--+BC!"#$%&'()*#+"#,-.(/(0%1(-!2(($- 30"#$)4"#5(-!6"7-!"#$$%&'(%)$*&+,$& -./$'& 0"1$2&($ 3&4"2&($ 05&.'%/".5$(%5"55.$6.$7%8&25$9%6:;&2 05&.'%<*9%="5$6 >$55.$6?==5$ 8"'"C 89:;<):%=()>6"0)?(,#5%@6A-)2#$B6"$)#A$(00"7@6ACThis mdified fibre diet may als be recmmended t thse patients underging external beam radiatin. If yu have any questins regarding yur diet during this perid please be sure t cnsult yur nurse r dctr. Page 6