Prostate Seed Brachytherapy

Transcription

1 Prostate Seed Brachytherapy Implant Patient Information Guide 2075 Bayview Avenue, T-Wing Toronto, ON Canada M4N 3M5 t:

2 Page 1 Page 10 Radiotherapy is an effective curative treatment for many men with prostate cancer. This can be given either by external radiation or by internal radiation, also called brachytherapy. The most common form of prostate brachytherapy involves inserting a large number of tiny radioactive seeds into the prostate. These seeds contain radioactive iodine, which slowly give off radiation over several months. The radiation dose is deposited almost exclusively within the prostate, which can kill off cancer cells with little risk of damaging surrounding organs. Other sources of information For a Canadian perspective, see: Canadian prostate cancer patient support: Visit TSRCC at Other questions you may have? Please write down any questions that you may want answered before your procedure. The amount of radioactivity decreases by half every 60 days. By 6 months about 85% of the radiation has been given, and it is almost entirely delivered by one year. Amount of Radiation Left Time in Months

3 Page 9 Page 2 Who can have seed brachytherapy? Although it is rare, an occasional seed may be lost via urination. If a seed is passed in this way, it almost always occurs within the first week following the implant procedure. If a seed is passed, it should be retrieved and returned to the Odette Cancer Centre for proper disposal. Due to possible passage of a seed, we ask you to strain your urine for the first week following the procedure so that any seed that is passed may be easily retrieved. The seed should then be picked up with a cotton swab or tweezers and placed in the packet provided. We ask that you return the packet to the clinic on your first follow up visit. A seed may rarely be passed in the semen. For this reason, we ask that you use a condom during intercourse for the first two months. Although these precautions may seem elaborate, the amount of radiation exposure to the patient and those around him are really quite minimal and do not represent an additional risk. Special precautions also need to be taken in the event of unexpected death within 12 months of the implant. As the seeds may still be radioactive, the cancer centre should be notified. This is particularly important if cremation was being considered Seed brachytherapy is commonly used to treat early stage prostate cancer confined within the prostate. The PSA should be under 10 and the Gleason Score 6 or less. If these parameters are not met, brachytherapy alone may not be the best option. In addition, there should be no evidence of urine blockage, and the prostate gland should not be too big. There are three steps in having a prostate implant: 1. A planning trans-rectal ultrasound (called a TRUS) 2. Implanting the radioactive seeds 3. A CT scan one month later to check the implant PLANNING TRANS-RECTAL ULTRASOUND (TRUS) The purpose of this examination is to accurately map out the size and position of the prostate. You will be lying on your back with your feet in stirrups. Some jelly will be put into the urethra so it can be seen on ultrasound. This can cause a little discomfort. You will need to have a fleet enema about one hour before the TRUS.

4 Page 3 Page 8 Some men experience impotence after an implant. Pain or discomfort on ejaculation is common during the first few weeks, and there may also be traces of blood in the semen. This sometimes can last quite a while. The quantity of semen may decrease over time, and it may become more sticky. This will not affect sexual pleasure. The ultrasound shows the size and shape of the prostate (outlined) as seen on TRUS The computer gives a 3-D image of the prostate, rectum, urethra and seeds. Seeds very rarely get into the bloodstream and travel to the lung. There is no evidence that this is dangerous to health. RADIATION SAFETY The TRUS is performed either by the physician or by a specially trained radiation therapist. The physician and dosimetrist then take the ultrasound pictures and use a computer to work out where the seeds need to go within the prostate. Typically, 80 to 120 seeds are required. IMPLANTING THE SEEDS A low dose spinal anaesthetic or, rarely, a short general anaesthetic can be used for the implant. In either case, an intravenous will be started by the nurse. The seeds are implanted using long thin needles that are inserted into the prostate through the skin in front of the rectum. An ultrasound probe in the rectum is used to guide the needles. Iodine-125 emits very low-energy radiation, which does not travel far. In fact, the vast majority of the radiation is stopped inside the prostate itself and only a tiny fraction escapes beyond the body. The amount that escapes is so small that it is not considered a risk for most people; nevertheless, small children and pregnant women may be more sensitive to the effects of radiation. Some additional precautions we recommend for these people when around the patient during the first two months following the implant are as follows: Avoid prolonged close contact with young children during this time, e.g. child sleeping on your lap. Avoid sleeping with a woman who is pregnant.

5 Page 7 Page 4 What are the side effects? At first, you may experience some slight bruising or soreness in the implant area, or blood in the urine. These symptoms will usually get better in a few days. Drinking lots of fluids helps. Use an icepack mins at a time 4-5 times daily for the first two days Seeds are inserted into the prostate under ultrasound guidance through the skin between the scrotum and anus. Note ultrasound probe in rectum. Other common side effects include frequent urination, burning with urination, a sense of urgency or a decrease in the force of the urinary stream. These symptoms are usually at their worst about 2 to 4 weeks after the implant, and are sometimes so severe that a catheter has to be inserted to allow you to pass urine. Very occasionally, the catheter is needed for a long period of time. These symptoms will usually decrease as the seeds lose their strength, but may be present to some degree for six to twelve months after the implant. Drinking plenty of fluids and avoiding caffeine-containing drinks may help to relieve these symptoms. If they are bothersome, medications will be prescribed. Minor rectal discomfort sometimes occurs after the implant, but serious rectal problems or urinary incontinence are both very rare. The seed implant procedure usually takes under an hour to perform. It is done in the High Dose-Rate Suite at the Cancer Centre. After the implant, you will go to the recovery room to be monitored briefly. You will have an ice bag placed between your legs to help reduce swelling and bruising. The intravenous will be removed when you are drinking well and you can go home once you have passed urine. Most men can go home within 1 or 2 hours. What preparation is required before the procedure? Usually on the day of your TRUS you will have blood tests done and possibly an electrocardiogram (ECG) and chest x-ray.

6 Page 5 Page 6 Before the implant, you will be given specific instructions regarding some diet changes and medications to make sure that your bowels are empty You will be asked to arrive at the Toronto Sunnybrook Regional Cancer Centre one hour prior to surgery. What can I expect after the procedure? Rectum Bladder Prostate with seeds When you have recovered from the anaesthetic and passed urine, you may go home. You may feel a little weak. It is recommended that you do not drive for at least twelve hours, so please arrange to have someone drive you home. A nurse will discuss discharge instructions with you before you go home. You must stay with someone for the next 24 hrs as per hospital policy You should avoid heavy lifting or strenuous physical activity for the first two days once you are home. After that, you may return to your normal activity level. THE ONE-MONTH CT SCAN CT Scan 1 month after implant showing seeds within prostate The CT Scan is used to check that the seeds are well positioned within the prostate and to calculate the amount of radiation being delivered. On very rare occasions some further seeds may need to be inserted if cold spots were detected. Follow-up visits with your urologist and radiation oncologist will be performed on a regular basis. These will include a physical examination and blood tests. One month following the implant, you will return for a CT scan and a blood test to measure the PSA and a follow up visit to see your physician and nurse. No special preparation is required.