What to expect after Iodine Seed Brachytherapy Implants Northern Centre for Cancer Care Freeman Hospital
Introduction This leaflet is for all patients who have just had an iodine seed brachytherapy implant to their prostate gland. The leaflet aims to give you general information and answer some of the questions you may have about the side effects of treatment. You will be given a credit-card sized card with details of your implant and our contact number on it. You should carry this card with you for the first three years after the implant. We hope you will find this helpful. If you have any further questions relating to your treatment, please do not hesitate to ask your oncologist, specialist nurse or GP. What is the most common side effect? A few days after leaving the hospital you will start to notice some discomfort when passing urine. You may find that your urine stream is reduced or is more difficult to start. These problems arise because the prostate gland becomes inflamed and swollen as the iodine seeds release radiation. Before you left the hospital you will have been given medication to take which should help to reduce some of the symptoms. Although these symptoms may not be completely relieved with medication, they will slowly improve with time. What medication will I be given? You will be given antibiotics for ten days to clear any infection which may have been introduced at the time of the implant. It is not usually helpful to continue with further additional courses of antibiotics. Tamsulosin is a drug you may have been given which relaxes the muscles at the base of the bladder and sometimes relieves some of the symptoms caused by muscle spasms. You should continue with this drug even though you may feel it is not helping a great deal. Dexamethasone (steroid) is given twice a day for one week to reduce swelling and inflammation. Once this course has finished 1
anti-inflammatory drugs can be taken if passing urine is very painful. These would include drugs such as Nurofen (Ibuprofen), which can be bought over the pharmacy counter or you may consult your GP for stronger alternatives if this is not effective. Dexamethasone and anti-inflammatory drugs should not be taken at the same time. These bladder symptoms may unfortunately persist despite the medication, however, they do eventually settle down. Will I need a catheter? You will have been told that there is a small risk that you may need a urinary catheter inserted to relieve a very swollen prostate obstructing the flow of urine or preventing you from fully emptying your bladder. This symptom is called urinary retention. This usually happens within the first two to four weeks of treatment and only affects about 10% of patients. If this does happen to you and you find that you cannot pass water, you will need to go to your local Emergency Department (A&E). Try to take this leaflet or the small credit-card sized card you have been given with you. If they have any concerns they can contact us on the telephone numbers given at the end of this leaflet, on the card or via the hospital switchboard. They should pass a small urinary catheter. This is a small flexible tube which will be put into your bladder through your urethra and will automatically drain your urine from your bladder into a bag. If this is difficult and unsuccessful after one or two attempts they should not continue without contacting a urology specialist, who may consider a suprapubic catheter rather than one through the urethra. A suprapubic catheter is inserted through the lower part of your abdominal wall into your bladder, rather than through your urethra. This is done because we wish to minimise trauma to your prostate area, as this can cause additional scarring when your treatment reaction heals. How long will the catheter stay in place? If you have been catheterised, this is likely to be in place for several weeks. The range of time that people have required 2
catheters after implants varies considerably from one or two weeks up to 12 months for a small number patients. The majority however require a catheter for only a few weeks until the maximum swelling has settled and they can pass water comfortably again. Unfortunately there is no way of knowing when this point has been reached other than by removing the catheter and seeing whether or not you are successful in passing water spontaneously (trial without catheter TWOC). We do not usually recommend this is tried sooner than two to four weeks after catheter insertion to allow the prostate time to settle down. Who will remove my catheter? The removal of your catheter will be arranged by the urology ward. Please be aware that very often the first TWOC is unsuccessful in which case you will need to be recatheterised. Although this is disappointing for you, we would nevertheless like you to be reassured that virtually all men (given time) do manage to pass water spontaneously again. Will any seeds come loose? Iodine seeds look like silver grains of rice. Occasionally a seed may be passed in your urine, so just flush it away down the toilet. If you find a seed in your bed don't pick it up with your fingers - use a spoon or tweezers and again flush it down the toilet. The radiation from individual seeds is very small and there is no need to worry about the effect of a seed to you or other people as long as the seed is disposed of down the toilet as soon as possible after the seed is found. You don't need to report this to the oncologist or a member of the team at the time, but please mention it at your next clinic visit. When will I know if the treatment has worked? This is understandably the most common question that patients ask once they have got over the procedure. Unfortunately we cannot give you a precise answer to this question until we have monitored the Prostate Specific Antigen (PSA) level for some time. The first time the PSA level will be measured with any expectation that it will give us useful information is at six months. This should then be repeated six monthly until two years 3
after implant when usually, if all is going well, annual PSA s are sufficient. There is no advantage in repeating the PSA more frequently than this. You should also be aware that small changes in PSA are rarely of significance and indeed it is well recognised that many men experience a 'PSA bounce' in which there is a small rise some months after implant. What about my sex life? Sexual activity can be resumed whenever you feel comfortable to do so. You may find, particularly on the first occasion that ejaculation is uncomfortable in the same way that passing urine is painful. You will also find that the ejaculate is blood stained and until it clears may appear a brownish colour for a little while. You are advised to use a condom for the first two months after the implant just in case a seed were to be passed when you ejaculate. Condoms should be tied tightly at the end, wrapped up securely in paper or a plastic bag and can then be discarded as usual. It is however important to emphasise that there is no risk from radiation to your partner from seeds in a condom and that it is safe to dispose of the wrapped condom in a bin. Can I return to work? If you wish to return to work you can do so as soon as you feel comfortable. The need to pass urine more often should be considered, as you may need to have easy access to a toilet. Radiation safety is a concern of many patients. However, iodineseeds are low energy radioactive materials and the body tissues absorb most of the radiation that they emit. Also, the strength of the radiation from the seeds reduces with time. The radiation level outside your body, arising from the seeds, is not much greater than the normal background level that exists in the natural environment. The risk to other people around you is therefore very low. Whilst there are no formal restrictions on your activities when you return home, we suggest you follow the guidelines listed below, for a period of two months after your operation, for your own and family's peace of mind. You may be given more specific advice if your spouse is already pregnant, or if you later advise us that she becomes 4
pregnant. Women who are (or maybe) pregnant should not sit very close (less than one metre) to you, on the same settee, for example. Apart from this there is no need for you to treat them any differently to how you would have done before your implant. You may greet them as you normally would, and they may stay in the same room as you for as long as they wish. Do not nurse children on your lap, or sit very close (less than one metre) to them for long periods of time. As above, you may cuddle or hold them for a few minutes each day, and they may stay in the same room as you for as long as you wish. Is there anything else I should know? You should be aware that if you were to die, for whatever reason, soon after any radioactive implant, the current recommendation states that there is a small risk of radiation being released from the iodine seeds into the environment during cremation. So if you were to die within three years of implantation you would need to be buried as opposed to cremated. After three years following implantation there are no restrictions. Please note that this information is given to any patient, male or female with any diagnosis, who has received any form of radioactive treatment. Obviously these are difficult topics for some people to consider and discuss, but we would recommend you let your family, carers or friends know about the restrictions. Useful contacts: Brachytherapy Nurse Specialist The Urology Department Freeman Hospital Tel: 0191 2336161 ask for Dect 48277 (Mon Fri 9am 5pm) Or for out of hours contact the urology registrar on-call: Tel: 0191 233 6161 5
Northern Centre for Cancer Care Macmillan Information and Support Centre 0191 2138611 Opening hours Monday to Friday from 9am to 4.30pm Newcastle upon Tyne Hospitals NHS Foundation Trust www.newcastle-hospitals.org.uk CancerBACUP freephone 0808 800 1234 www.cancerbacup.org.uk Macmillan Cancer Relief Head office 020 7840 7840 freephone 0808 800 1234 www.macmillan.org.uk Information produced by the Urology team at NCCC September 2011 Review date: September 2013 Patient Information Series R/T 37 6