We would like you to be able to use this information as a basis for any questions you may have about prostate brachytherapy as a potential treatment choice for your early-stage prostate cancer.
It is estimated that 1 in 9 men will develop prostate cancer during their lifetime. If prostate cancer is detected early, there are several methods of treatment currently available which provide a good chance of a cure. Choosing the treatment option that is best for you should involve obtaining enough information to allow you to understand what each treatment involves.
You should make an informed decision in close consultation and discussion with your doctor.
This procedure involves the insertion of radioactive seeds directly into the prostate gland where they remain. The seeds emit low level radiation for approximately 1 year after implantation. Each seed is 4.5mm in length and 0.8mm wide and resembles a grain of rice, grey in colour.
Each seed gives off radiation to a small surrounding area. By careful placement of the seeds, very high doses of radiation can be delivered to areas of the prostate affected by the cancer, and relatively little radiation is received by the normal tissues. These include the rectum which is directly behind the prostate gland, and the bladder which lies on top of the gland. This is the reason why the side effects of brachytherapy are moderate.
Convenience - the treatment is usually delivered as a day case on 2 separate occasions.
At the present time, the results of surgery, radiotherapy and brachytherapy suggest that they are all equally successful in treating prostate cancer. It is important that you understand what is involved in each treatment so you can make an informed choice. All treatment options have a small chance of severe complications which may lead to permanent problems.
This involves a visit as an outpatient to The Christie. You will have a consultation with a doctor, blood tests, ECG, and give consent for the procedure. You can drive yourself to the hospital and home again. The visit may take several hours.
You will be asked to sign a consent form agreeing to accept the treatment that you are being offered. This is based on the understanding that you have read the booklet provided and have been given an opportunity to discuss any concerns.
Consent may be withdrawn at any time before or during treatment. Should you decide to withdraw your consent, then a member of your treating team will discuss the possible consequences with you.
You will be given an enema to clear out the lower part of your bowel which is essential so that we can take high quality ultrasound images. Your implant will be planned on these images. You will have a short general anaesthetic whilst an ultrasound probe is placed in your rectum to visualise the prostate gland. A catheter is also inserted into your bladder.
This scan is also the final check that a seed implant is an appropriate treatment for you. This is because it is only at this stage that we can accurately measure the volume of the prostate gland, and its position in relation to the bones in your pelvis.
Sometimes it may become apparent that the gland is too large [more than 60cc] to proceed to implant straight away. In this case your doctor may recommend a 3-6 month course of hormone treatment to shrink the prostate before the implant. You would then have a repeat planning study about 3-6 months later.
Very occasionally the doctor can see that, even if the gland size is small, an implant would be technically impossible because of the position of the pelvic bones in relation to the prostate gland. Prostate brachytherapy would then not be an appropriate treatment for your early stage disease. We would discuss other options fully with you.
When you have recovered from the anaesthetic, you may go home, although you should not drive for 24 hours after the procedure. Before you leave we will give you a date to come back for your implant. This is usually 2-6 weeks later.
At this time we advise anyone taking asprin daily or other anti-coagulants, to stop taking this until after their implant. Continuing these could cause the prostate gland to bleed excessively at the time of implant which could compromise the success of the treatment.You will be admitted to the hospital early in the morning on the day of your implant, so that you can have an enema before the implant.
The implant will be performed under general anaesthetic and usually takes about an hour.
There is no surgical incision. Instead the seeds are loaded within fine needles which are inserted through the area of skin between the scrotum and the anus (perineum) into the prostate gland.
The needle can be seen on the ultrasound image and is guided to the planned position within the prostate. It is then withdrawn, leaving the seeds at the exact locations.
On average, about 70 seeds are accurately positioned in this way, contained within approximately 30 hollow needles.
Your catheter will then be removed before you wake up from your anaesthetic.
You will then return to the ward. Once you have had something to eat and drink, you will be encouraged to get up and dressed as soon as possible. You will also be given some medication to help you start urinating.
Most patients go home the day of the procedure, a few the following day.
Before you leave hospital, the staff will advise you about how to manage any side effects, and give you instructions about your medication and the follow-up clinic arrangements.
For the first few days after treatment, you should not take part in any strenuous activity or heavy lifting, but after this you will probably be able to carry on as normal.
On the day of implant, you will start taking a medicine called Tamsulosin (Flomax). This helps you to urinate. You may need to remain on Tamsulosin for 3 months or more until your symptoms settle, and we advise you to stop taking them. If you need a repeat prescription, you should get this from your GP. Remember to take Tamsulosin with your evening meal as this medicine can make you dizzy.
Ibuprofen is usually given for its anti-inflammatory effect and should be taken to treat any discomfort or pain. If this is unsuitable for you, for example if you are asthmatic, please discuss an alternative medication with your medical team.
We will also prescribe antibiotics (which you should finish) to prevent any risk of infection.
Immediately after the implant, when the catheter has been removed, you may notice a burning sensation when passing urine.
There may also be some blood in the urine. This is to be expected and you can help by drinking plenty of water to help flush your bladder.
You may have some discomfort and bruising in the perineal area. This may sometimes track down into the scrotum and upper thigh area. Mild painkillers and a warm bath will ease this.
As the bruising and swelling from the implant procedure itself subsides, the radiation reaction from the seeds begins to build, peaking about seven to ten days after the implant. The reaction stays at this level for four to six weeks on average, and then begins to decrease in severity. This may include a range of symptoms described below.
Some 5% of men may get acute retention of urine and need to have a catheter. This is when you cease to pass urine at all, and your bladder becomes uncomfortably full. If this occurs, you should contact your GP or local hospital immediately. If you do have a catheter fitted, please notify us as soon as you can on 0161 446 3048.
When you have a catheter, it is usually advisable to allow 4 to 6 weeks for the situation to settle before trying without one. In rare cases it may remain in for several months beyond this, to allow a more severe reaction to settle. We may teach you to insert a catheter yourself. This is called intermittent self-catheterisation (ISC). Urine retention usually begins in the first few weeks after an implant, but can occasionally happen later.
Pain at the tip of the penis (this is referred pain from irritation of the nerves).
A more frequent urge to open the bowels (due to pressure from inflamed prostate).
Sometimes you may feel as though you are constipated, this could be the result of the prostate swelling. A high fibre diet and drinking more fluids can be helpful in easing this.
Rectal discomfort/bleeding. If you are very concerned, please contact us. You will be monitored closely but this usually settles down without treatment.
These symptoms may not all occur, will vary in severity, and last on average for up to six weeks. After this time, most men notice a marked improvement, although it can take up to a year for some of the irritative urinary symptoms to resolve.
After the implant, the urethra (the tube that leads from the bladder through the prostate and penis) can become inflamed causing some restriction of urinary flow. Drinking a total of 2 to 2.5 litres gradually throughout the day (water, fruit juices, squashes) helps to relieve some of the symptoms.
Cranberry juice: drinking 1 to 2 glasses per day may help to reduce the risk of urine infection (patients on warfarin should not drink cranberry juice).
Both tea and coffee contain caffeine which has a stimulatory effect on your urine output, so it's advisable to cut down on these especially before bed. Decaffeinated drinks are better.
If you are passing urine frequently during the night, try reducing fluid intake a few hours before bed and have sips of water if you need to during the night.
If your urine flow is poor, try sitting down to urinate.
If you have to wait before urine starts to flow, having a warm bath can help.
There is little evidence about the effects of prostate brachytherapy on a man's fertility (ability to father children). If this is an issue for you, please consult your medical team before starting treatment.
There is a small risk (less than 1%) of incontinence with seed implant brachytherapy.
Impotence occurs in 40 to 50% of men under the age of 60. In older men impotence occurs more often. Treatment is available for those men who do develop impotence and can often be successful.
Because the prostate is responsible for semen production, most men will notice a reduction in the volume of their ejaculate following treatment. Eventually the ejaculate may dry up altogether. Sometimes ejaculation may also be uncomfortable, this tends to settle with time.
Persistent inflammation of the rectum (proctitis) occurs rarely (in less than 1% of patients).
As with all medical procedures, including all treatment options for prostate cancer, there is a small chance (less than 1 in 100) of long term permanent damage. This may require further treatment including surgery. Your clinical oncologist will discuss this with you.
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