NORTHSIDE HOSPITAL CANCER CENTER UNDERSTANDING RADIOACTIVE SEED IMPLANTS AN INFORMATIONAL HANDBOOK FOR PATIENTS AND THEIR FAMILIES DANIEL SHASHA, MD WEBSITE: DOCTORSHASHA.COM EMAIL: PHONE:
INTRODUCTION There are several ways cancer of the prostate can be treated. This booklet is intended to review the Radioactive Seed Implant. We will explain in great detail what can be expected during treatment and what precautions you may need to take as a result of treatment. The prostate gland is located at the base of the penis just below the bladder and above the rectum. Its function of the prostate is to produce fluid that will transport semen during ejaculation. Though the shape and size of the prostate may vary, it is usually about two to three inches in diameter roughly the size and shape of a large walnut. Like other cancers, prostate cancer is a disease of the body s cells. Cells reproduce themselves by dividing, and normal growth and repair of tissue takes place in this orderly manner. Cancer is an abnormal growth which may invade and destroy nearby tissues and organs or spread to other parts of the body. Though cancer may take place in any part of the prostate, it is most commonly found in the outer portions. The disease is most common among older men and its cause is unknown. EXPLAINING THE RADIATION TREATMENT Doctor Shasha s priority is to kill the cancer in your prostate. In order to do this, radioactive seeds will be implanted into your prostate gland. Two types of radioactive seeds commonly used for prostate cancer are - Iodine 125 or Palladium 103. They deliver low energy X-rays that very effectively destroy prostate without affecting the rest of the body. Iodine 125 (also known as I-125) and Palladium (also known as Pd 103), give up to 90% of their radioactivity within a two to six month period. By one year, the radioactivity can be considered nearly completely gone. Your radiation oncologist will choose the isotope that is best for your condition. The radioactive seeds are about the size of a dry grain of rice. Seeds are hollow metal tubes that contain radiation. The seeds remain permanently in the prostate, and the radiation completely dissolves in less than a year. Thirty to fifty seeds are typically implanted into the prostate during a painless one-hour outpatient procedure done under anesthesia. Because there may be microscopic amounts of cancer throughout your prostate gland, aside from the portion where the cancer is visible, the entire gland is treated.
THE IMPLANT: BEFORE AND AFTER THE PROCEDURE One to four weeks before your implant procedure, a map of your prostate will be made by Dr. Shasha using a prostate ultrasound. This procedure is called a volume study. Dr. Shasha and his dedicated staff of expert radiation physicists and dosimetrists, aided by sophisticated computers, will use the volume study to determine the number of seeds needed to treat the cancer, their strength and exactly where in the prostate the seeds should be placed. The implant procedure typically lasts less than one hour in total. You will be discharged from the hospital the same day as your implant procedure. Anesthesia is always given to avoid any pain during the procedure. The implant procedure does not require open surgery. No scalpel is used and there will be no cutting of skin or sutures placed. Instead a small round ultrasound probe is placed in your rectum, which provides the physician with a picture of your prostate gland on a screen. Needles are then passed through your skin in the perineum which is located between the rectum and scrotum. All needles are precisely guided by Dr. Shasha into the correct position using real-time direct visualization. The seeds are then injected through the needles and implanted into the prostate. After the implant is completed, the probe and the needles are removed, and then your urologist, may examine your bladder using a cystoscope. At the very end of the procedure, a catheter will be placed to drain urine and wash out any blood clots that may have formed. After the procedure, you will be taken to the recovery room. Once you are fully awake in the recovery room, you will then be transported to have a CT scan done to verify seed placement. The urinary catheter will be removed after you have returned from the CT scan You will be discharged home after the catheter is removed and after you have urinated at least twice. Discharge instructions with your next appointment, and a travel-letter advising airport security personnel of the reason for your radioactivity (for one year) will be provided to you by the recovery room staff before you leave. You will see Dr. Shasha and the urologist about one month after your procedure, or sooner if you need to for any reason. PREPARING FOR THE PROCEDURE Some preparation is required before performing a seed implant. In the days or weeks prior to your procedure, you will be given written instruction on the same dietary changes and use of enema necessary both prior to the preparatory ultrasound and prior to your seed implant. This will help remove fecal material out of your lower bowel and rectum to ensure accurate imaging of your prostate during the planning session and the implant. Approximately one week prior to the implant, your primary care team will arrange for a series of tests ( medical clearance ) including blood tests and electrocardiogram
(EKG) and chest X-ray. Your primary doctor will determine which tests are necessary and will help inform the anesthesiologist of your ability to tolerate anesthesia. SIDE EFFECTS You may have a few side effects after the implant procedure. Though these side effects are minimal, you may experience mild burning during urination, urinating frequency or urgency, or slight urinary hesitancy. Medications will be prescribed in advance to reduce urinary symptoms and to prevent infections. Pain is not expected, but if it does occur Tylenol alone typically provides excellent relief. These symptoms are common and ordinarily stop in one to four months. However, if you are uncomfortable, feel free to contact Dr. Shasha or your urologist. 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 Due to anesthesia, all patients must be accompanied by another person at the time of discharge and should not be left alone for 24 hours. Also, No alcohol or recreational drugs should be taken for the first 24 hours after anesthesia. You may resume a normal diet immediately upon discharge, but should not drink any alcohol or do any recreational drugs for at least 24 hours after anesthesia. You may shower and return to work the day after your implant, and may bath or resume exercise or intercourse (with a condum) one week later. You should avoid lifting objects heavier than 25 pounds for the first week after your procedure. Prescriptions for medications you are to start taking before your seed implant will be provide to you 1-3 weeks in advance by Dr. Shasha and his team. You should resume daily aspirin or other prescribed blood thinners 3 days after you do not see any blood in your urine. 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. MRI scans: There is NO problem having MRI scans as a result of your seed implantation. FOLLOW-UP Follow-up with your urologist and radiation oncologist will be done on a regular basis, usually every three to six months for routine visits. Physical examination, blood tests and ultrasound tests may be done at certain intervals during these visits. DR. SHASHA CONTACT INFORMATION Please, feel free to ask any questions you may have prior to or after the procedure. 1. Office phone number: ( 2. Email address: 3. Website address: DoctorShasha.com