DISCHARGE INSTRUCTIONS FOLLOWING PROSTATE SEED IMPLANT

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1 DISCHARGE INSTRUCTIONS PRESCRIBED MEDICATIONS: 1. ANTIBIOTIC: Ciprofloxacin, or Levaquine, or Bactrim (trimethoprin and sulfamethoxazole) are typically given the day before and for 5 days after the implant to prevent infection. 2. PROSTATE MEDICATIONS: Flomax (tamsulosin), Uroxatrol (Alfuzosin), Rapaflo (silodosin), and/or Proscar (finasteride) or Avodart (dutasteride) are typically given to prevent urinary blockage. 3. ANALGESICS: Tylenol (acetominophen) for pain. Do NOT take aspirin or nonsteroidal antiinflammatories (such as Advil, Motrin, Aleve, etc), or blood thinners until 72 hours after no blood in the urine is seen. DIET: Regular, unless you are on a special diet for other reasons. ACTIVITY: 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. Avoid bicycle riding for one year after the procedure. You may shower the day after your procedure, and take a bath or swim 7 days later. POSSIBLE SIDE EFFECTS: There are very few side effects from the implant procedure. However, minor burning on urination, urinating more frequently especially at night time, mild pain, or feeling unable to pass urine freely may occur and usually stop in a few months. 1. Blood in urine and/or ejaculate is common after the implant for the first few days. If after twenty-four hours, visible blood persists or if you begin to pass clots, you should contact your radiation oncologist, urologist, or primary care physician. 2. For frequent urination: Drink only when thirsty. Try not to eat or drink for 3 hours before bedtime, except with medications. Try to avoid any caffeinated beverages (coffee/decaf, tea, cola) or alcohol (beer, wine, spirits), as these will result in more frequent urination. 3. For burning with urination: Avoid spicy foods, citrus fruits and juices (orange, grapefruit, pineapple), alcohol, coffee/decaf. 4. For constipation/hemorrhoidal bleeding: Take fiber powder such as Metamucil twice daily and avoid coffe/decaf.

2 5. Urinary blockage: Go to your urologist or radiation oncologist or to the emergency room immediately in the unlikely event that you cannot urinate. DISCHARGE INSTRUCTIONS POSSIBLE SIDE EFFECTS (continued): 6. Decreased volume of ejaculate is expected and is common. Remember, that radiation treatments are NOT birth control and that conception is possible, but less likely than before your treatments. You may increase the volume of your ejaculate by making lifestyle and dietary changes, and with supplemental vitamins: a. Drink fluids. The amount of semen that is released during orgasm is related to the volume of fluids that are ingested. That's because semen is water-based, and semen is the fluid that helps lubricate the way for sperm. Drinking more fluids should therefore increase your ejaculate. b. Minimize or avoid alcohol consumption or soda. Alcohol dehydrates your body, and lowers sperm count and affects the quality of your sperm. Soda consumption has also been correlated with lowering sperm counts as a result of high-fructose corn syrup. c Avoid heat or tight underwear. Hot baths, hot tubs, saunas, and tight underwear all increase scrotal temperature, thereby decreasing sperm and semen levels. d. Abstain from orgasm for a few days. Men normally produce ore than 1,500 sperm every second on average, and anywhere from 130 million to 200 million sperm cells daily. By abstaining for a short while, you will replenish the volume and will ejaculate greater quantities. e. Take 1 mg zinc sulfate with 15 mg folate (folic acid) in combination, both essential to increase sperm count by as much as 74% and semen volume. f. Take amino acids such as L-Arginine or L-lysine or L-carnitine, all of which are building blocks of proteins, including sperm. g. Eat more fruits and vegetables, including red beans, blue berries, cranberries, black berries, coconut water, prunes, apples (Red Delicious, Granny Smith, Gala), artichokes. The antioxidants in these can help improve the quality of your sperm and help your health overall. h. Avoid cigarette smoking. Cigarettes have been shown to lower sperm count and increase abnormalities in sperm. i. Exercise and stress reduction have been shown to increase sperm count and improve sexual performance and enjoyment.

3 DISCHARGE INSTRUCTIONS RADIATION SAFETY The low energy of the seeds means that their radiation is contained within the prostate gland, for the most part. The radiation dissolves over time, with half of it being gone within 2 months, and all of it gone by 1 year. Objects that you touch or items that you use are NOT radioactive. Your bodily wastes (urine and stools) are NOT radioactive. PRECAUTIONS: Children and pregnant women should avoid prolonged close contact with your waist for the first two months after the implant. They can safely sit next to you at the dinner table or in the car, for example where there is no limit to the length of time they can be with you. Exercise: You may resume all forms of recreation and exercise one week after your procedure. Refrain from long bicycle rides for one year after your procedure. Sexual intercourse with a condom may be resumed one week after the implant. Your sperm may be discolored dark brown to black. This is normal and is a result of bleeding that may have occurred during the implant and is now being released into the ejaculate. You may also notice decreased volume of ejaculate as a result of medications prescribed and the radiation treatment(s). Please, see above recommendations that may help increase quantity of ejaculation and quality of sperm. We advise patients to wear a condum for the first 5 ejaculations or for the first month, 2 months, whichever comes first. Patients and their partners must be aware that radiation treatments for prostate cancer are not birth control, and conception is possible if proper precautions are not followed, although pregnancy is less likely. We advise patients and their partners to consider cryopreservation (freezing) of sperm prior to implant if pregnancy is or may be desired in the future to maximize probability for conception. Traveling: Radiation from your seed implantation may be detectable when travelling through airports, trains stations and bus stations. We will provide you a letter on the day of your implant detailing your procedure, that you should bring with you for the first year whenever traveling in the event that you are asked.

4 MRI scans: There is NO problem having MRI scans as a result of your seed implantation. DISCHARGE INSTRUCTIONS FOLLOWING PROSTATE SEED IMPLANT FOLLOW-UP: Approximately Thirty Days After Surgery 1. With your urologist. Please, phone his/her office to make an appointment. 2. With Dr. Shasha for a blood test and brief physical examination at (ADDRESS) Date: Time: FUTURE FOLLOW-UP: On an ongoing basis every 3-12 months: After the implant, you will need regular checkups to evaluate for any ongoing or new symptoms, for surveillance to check on the status of your cancer, and to prevent any future problems. It is important that you have regular checkups to be sure the cancer problem is taken care of and also to be sure there are no unusual problems from your treatment. You should arrange these follow up appointments with both your radiation oncologist and your urologist. Frequency of Physician Visits: About every 3-6 months for 1-2 years. Then, every 6-12 months after that. Occasionally, it may be necessary to change the schedule according to your needs. Each Follow-up Visit Should Include: 1. Blood tests (PSA, Testosterone and possibly other testing) 2. Digital rectal examination 3. Urinary assessment CONTACT DR.SHASHA WITH ANY QUESTIONS OR CONCERNS:

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