Prostate Brachytherapy
Procedure Overview

Introduction

LDR Brachytherapy utilizes ultrasound imaging to visualize the needles for accurate placement of small radioactive sources (seeds) directly into the prostate. Ultrasound imaging allows for accurate planning, placement and implantation of the radiation sources.

Implantation of the radioactive sources is a minimally invasive procedure, which can be performed in an outpatient setting (does not require a hospital stay) and generally takes approximately one to three hours to perform. Either Iodine-125 (I-125) or Palladium-103 (Pd-103) radioactive seeds are inserted through the perineum skin (the area between the scrotum and the anus) into the prostate gland. Your doctor will determine which isotope is most appropriate for your specific condition. With correct planning, your surgeon can implant the radiation sources for maximum benefit to effectively treat the cancer.

After your doctor has determined the stage of your cancer, you and your doctor will discuss whether or not brachytherapy is the best treatment option for you. For brachytherapy treatment, Core Oncology offers two radiation sources that are designed to be permanently implanted into your prostate gland.

Your doctor will determine the appropriate radiation dosage.

Before the Procedure

Some physicians may choose to preplan your implantation. If your physician follows this approach, approximately two days before your implantation you will undergo a series of standard tests such as a blood test, an electrocardiogram (EKG), chest X-rays, etc. An ultrasound volume study may be performed approximately two weeks prior to surgery to let your doctor know the exact size, shape, and location of your prostate. The data from the ultrasound will tell your doctor how many radiation seeds you require and where they should be placed. At the completion of your ultrasound volume study, your doctor will create a prospective "implantation map," or preplan, for seed placement.

The Implantation Procedure

Your doctor will use the implantation map, or preplan, to accurately place 60- 120 seeds into your prostate gland. You will be placed under spinal or general anesthesia and a probe will be inserted into your rectum. The probe gives your doctor continued visualization of your prostate via ultrasound or fluoroscopy.

When visualization is established your doctor will insert a specified number of needles into your perineum. The needles will be used as a conduit for seed implantation. It is through these needles that your doctor will permanently implant Iodine 125 or Palladium 103 radiation sources. Implantation is performed in an outpatient setting (does not require a hospital stay) and generally takes approximately one to three hours.

After the Procedure

After the procedure you will be taken to the recovery room until the anesthesia wears off. At such time, you may be able to go home with a catheter in place. Your doctor may, however, suggest an overnight stay. Your doctor will provide you with post-implantation guidelines to follow that are specific to your case. In general, you will be able to resume eating directly after your release; you do not have to follow any specific diet, unless your doctor recommends you to do so. Your doctor may recommend that you avoid strenuous activity for a period ranging from two days to two weeks. After the specified time you should be able to return to your normal activity level.

After your implantation, you should expect slight bleeding, bruising and tenderness at your implantation site, as well as bleeding when you urinate. These side effects should subside a few days after your surgery. You may also experience frequent urination, urination urgency, burning when urinating, and a weaker urination stream. Your physician can prescribe medications to alleviate your symptoms. Your doctor will give you a complete description of what you should expect during your treatment period.

Radiation precautions — While you are undergoing treatment, there are certain precautions you need to take due to the radiation in your body. The following list is a sample of the precautions you may need to take during the first two months following implantation. Ask your doctor to give you a complete explanation of the specific precautions you should take. These precautions may include:

• Do not let children sit on your lap.
• Avoid prolonged contact with pregnant women closer than six feet.
• Use a condom during intercourse because you may discharge seeds in your ejaculate.

After you have undergone treatment with the brachytherapy "seeds," they will remain in your body. Radiation decays over time; the seeds will lose their radioactivity after about one year. Though the seeds are designed to remain in place, after implantation some may be carried out of your body through your urine flow. The loss of these seeds should not raise alarm, but you should follow your doctor's recommendation on how to retrieve the seeds. Your doctor will explain these and other precautions at the time of your procedure.