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Seed Radiation For Prostate Cancer

How Long Has This Procedure Been Around

Which is Better – Surgery vs. Radiation for Prostate Cancer?

Using internal radioactive sources to treat cancer is not a new concept it emerged over 100 years ago. However, radioactive seed localization specifically is a relatively new technique the first procedure in the Ottawa Hospital Radioactive Seed Localization Program was on April 21, 2015. Our hospital was the third centre in Canada to have this program, and we are a leader in the procedure, with other healthcare centres looking to us for guidance.

Swelling Bruising Or Tenderness Of The Scrotum

Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.

Influence Of Seed Migration On Postimplant Dosimetry

The postimplant prostate D90 was not significantly different between patients with and without seed migration. Moreover, in 15 patients who had multiple migrated seeds, the postimplant prostate D90 was relatively acceptable, and no supplemental seed implantation was required. These results indicate that seed migration did not have a significant effect on postimplant prostate dosimetry in the present study. Possible reasons are as follows. First, in most patients with seed migration, only one or two seeds had migrated, which would have less effect on the dosimetry of the prostate. Tapen et al. have suggested that the loss of a few seeds may not have a significant effect on dose homogeneity or total dose to the prostate . Second, seed migration would have much less effect on the dosimetry of the prostate than other mechanisms of seed loss, such as seed misplacement to the seminal vesicle or perineum and being voided in the urine postoperatively. Merrick et al. have reported that seed migration to the chest accounted for only 10% of total seed loss from the prostate region, highlighting the importance of other mechanisms of loss .

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Radiation Therapy For Prostate Cancer

Radiation therapy is an effective treatment that kills prostate cancer cells by using high energy rays or particles. The radiation can be delivered in several ways, including brachytherapy and external beam radiation that projects the energy through the skin. Radiation therapy for prostate cancer is best delivered by experienced radiation oncologists who work in high volume centers of excellence.

Radiation therapy can:

  • Treat both early stage cancers of the prostate gland and more advanced cancers that may have spread beyond the prostate
  • Be used alone or with other treatments such as hormone deprivation
  • Treat recurrent prostate cancer following surgery
  • Treat men with limited spreading prostate cancer to reduce the tumors size and improve survival and quality of life
  • Slow cancer growth, reduce fracture risk
  • Be used as a palliative treatment to address pain from advanced cancer

Coping With The Side Effects

Radioactive Seeds in a Patient with Prostate Cancer

The side effects of both surgery and radiation can vary from mild to more severe and potentially significantly impact someones life.

The side effects of urinary and bowel problems can be distressing. There are ways to help manage these, such as with pelvic floor exercise, bladder training, and incontinence products. Other coping strategies include:

  • Urinating every few hours
  • Limiting caffeine intake
  • Talking to your healthcare team about any medications or other interventions that may be helpful

Sexual dysfunction related to prostate cancer treatment can also be an unwelcome side effect. Helpful ways to cope with this can include:

  • Having open communication with your partner
  • Prioritizing activities for the day and taking breaks as needed

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Permanent Versus Temporary Brachytherapy

In addition to permanent brachytherapy, temporary brachytherapy has also been used. In this technique, the implants deliver radiation to the prostate at a higher dose rate than is provided by a permanent implant. Currently, the isotope most commonly used for temporary brachytherapy is iridium -192, which provides a higher dose of radiation than the iodine -125 and palladium -103 permanent implants.

For high-dose-rate brachytherapy , a preplan is devised using TRUS to deliver 15 Gy/h to the prostate and smaller doses to the urethra and rectum. During the implantation, hollow needles are inserted transperineally and checked via TRUS to ensure reproduction of the preplan template. The needles are then connected to an automated remote-controlled loading machine. This device successively moves Ir-192 wires into the needles to the dwell positions for various durations. The total irradiation time is usually only 5-10 minutes.

HDRB is commonly delivered in 2 or more fractions of 810 Gy or more, with 6-24 hours between treatments. Patients require hospitalization while the implants remain in place but may go home once the implants are removed.

HDRB is usually used in combination with IMRT. The optimal patient population has not yet been determined. Most series reported are from single centers.

The American Brachytherapy Society has published consensus guidelines for high-dose-rate prostate brachytherapy, which note a growing experience with the use of this modality as monotherapy.

After The Implant Surgery

Most patients are discharged three to four hours after the implant procedure. Occasionally, a patient may need to be observed in the hospital until the next day. Your urologist will determine when you will be discharged from the hospital.

You will be given specific instructions about your implant. Keep these instructions so you can share them with your family members or with any doctors you see after your implant. The instructions will answer any questions you may have about radiation exposure to your family and friends after the implant. They are the same precautions that the radiation oncologist discussed with you.

There is little discomfort after the implant. Some patients do experience mild soreness when they sit. This soreness may last for one or two days after the implant. Sometimes, a patient will notice small spots of blood on his underwear after the procedure. This comes from the spot where the needles were inserted and should stop within 24 hours. Applying mild pressure with a clean cloth will stop the spotting. You may notice a small amount of blood in your urine. This is normal and should stop within one to two days after the implant. If the blood in your urine lasts more then two days, or if you see clots, call your urologist.

You should avoid heavy lifting or hard, physical activity for the first two days that you are home. After that time, you may return to your normal activity level.

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Side Effects And Complications

Common side effects of prostate brachytherapy include:

  • Blood in the urine: This is normal and should resolve within a few days
  • Bruising and tenderness of the perineum
  • A burning sensation when urinating: Drinking plenty of fluids will help to minimise this and will help prevent urinary infection
  • Difficulty passing urine, or an urge to pass urine quickly or more often
  • A temporary increase in the frequency of bowel motions
  • Fatigue: this is common to all types of radiation treatment.

These side effects are at their most troublesome four to six weeks after the procedure. However, for most patients they will subside completely over a period of a few months. More serious side effects can occur, including:

  • Urinary incontinence
  • Erectile dysfunction
  • Prostate brachytherapy may result in infertility.

The risks and side effects of brachytherapy should be discussed with the specialist prior to treatment and should be considered when deciding whether or not to opt for this treatment. More detailed information about the treatment and radiation safety guidelines will be given by the specialist performing the procedure.

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How Many Hospital Appointments You Might Have

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You might have the treatment during 1 or 2 stages. This depends on what is available at your hospital.

1 stage procedure

If you have the 1 stage procedure you have your brachytherapy planning and treatment on the same day. And you might stay in hospital for a night afterwards.

You’ll also have an ultrasound scan a few weeks before treatment to check you’re suitable for treatment and to work out how many seeds you need.

2 stage procedure

Some hospitals do your planning 2 to 4 weeks before your brachytherapy. At the planning session you have an ultrasound to check how many seeds you need in your prostate.

Then at your second visit your doctor puts in the radioactive seeds. This is called a 2 stage procedure.

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Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy

When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.

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Frequent Urination Burning With Urination And Difficulty Urinating

These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.

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What Other Details About The Radioactive Seed Implant Procedure Are Important

Close, prolonged contact with young children should be limited to 20 minutes per hour for the first two months after the procedure. Its safe to sleep in the same bed if your partner/spouse is NOT pregnant. If your partner/spouse is pregnant, separate sleeping arrangements will be necessary for two months. If you have other questions, please call your radiation oncologist or urologist.

Last reviewed by a Cleveland Clinic medical professional on 11/30/2020.

References

Your Role On Your Radiation Therapy Team

Radioactive Seeds in a Patient with Prostate Cancer

Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:

  • Getting to your appointments on time.
  • Asking questions and talking about your concerns.
  • Telling someone on your radiation therapy team when you have side effects.
  • Telling someone on your radiation therapy team if youre in pain.
  • Caring for yourself at home by:
  • Quitting smoking, if you smoke. If you want to quit, call our Tobacco Treatment Program at .
  • Caring for your skin as instructed.
  • Drinking liquids as instructed.

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How Is The Radioactive Seed Inserted

Using a mammogram as guidance, a radiologist places one seed, so tiny it can be safely injected with a needle, inside the tumour. It emits a very small amount of radiation that is picked up in the operating room with a small, handheld Geiger counter. After the piece of breast tissue with the radioactive seed is removed, the seed is separated from the tissue and appropriately disposed of, with every seed being accounted for.

Seed Migration To The Kidneys And Batsons Vertebral Plexus Is Not Very Rare

The results of the present study show a total of four and five cases of seed migration to the kidneys and Batsonâs vertebral venous plexus, respectively, at only one institution, which suggests that such cases are not very rare. Meanwhile, in previous studies, a total of only four and four cases of seed migration to the kidneys and Batsonâs vertebral venous plexus, respectively, have been reported as rare cases, which is in disagreement with our conclusion . The same number or more cases of seed migration to these areas were found in our single study compared with all previous studies. A possible explanation is that, in the present study, orthogonal chest radiographs, an abdominal radiograph, and a pelvic radiograph were undertaken routinely to detect seed migration to the chest, abdomen, and pelvis at several time points after seed implantation. Moreover, in all patients who had seed migration to the abdomen and pelvis, a CT scan was undertaken to identify the exact location of the migrated seeds. Consequently, more cases of seed migration to the kidneys and Batsonâs vertebral venous plexus were found in the present study. We speculate that some seed migration to the kidneys and Batsonâs vertebral venous plexus might have gone undetected in other institutions.

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Will Radiation Therapy Make Me Tired

Everyone have their own energy level, so radiation treatment will affect each person differently. Patients often feel fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy may require some patients to change their daily routine.

If your doctor thinks you should limit your activity, they will discuss it with you.

To minimize fatigue while you are receiving radiation treatment:

  • Be sure to get enough rest.
  • Eat well-balanced, nutritious meals.
  • Pace your activities and plan frequent rest periods.

Diarrhea Flatulence Or Painful Defecation

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These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.

Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.

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What Are The Advantages And Disadvantages

What may be important to one man might be less important to someone else. Your doctor, nurse or radiographer can help you choose the right treatment for you. Theres usually no rush to make a decision, so give yourself time to think about things.

Advantages

  • Recovery is quick, so most men can return to their normal activities one or two days after treatment.
  • It delivers radiation directly into the prostate, so there may be less damage to surrounding healthy tissue, and a lower risk of some side effects.
  • You will only be in hospital for one or two days.
  • If your cancer comes back, you may be able to have further treatment.

Disadvantages

  • It can cause side effects such as urinary and erection problems.
  • You will usually need a general or spinal anaesthetic, which can have side effects.
  • It may be some time before you know whether the treatment has been successful.
  • You will need to avoid sitting close to pregnant women or children during the first two months after treatment.

If you are having external beam radiotherapy or hormone therapy as well as permanent seed brachytherapy, think about the advantages and disadvantages of those treatments as well.

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Proton Beam Radiation Therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

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Seeds That Migrated To The Abdomen

Two of the 19,236 seeds migrated to the liver in two of the 267 patients: a single seed migrated to the liver in each of two patients. Five seeds migrated to the kidneys in four patients: two seeds migrated to the same kidney in one patient, and a single seed migrated to the kidney in each of the remaining three patients. In one patient , one day after seed implantation, an abdominal radiograph showed that a seed had migrated to the right side of the middle abdomen, which was considered to be separated from the inferior vena cava . However, two weeks after seed implantation, an abdominal radiograph showed that the seed had disappeared from the right side of the middle abdomen, and showed a seed that had migrated to the left side of the middle abdomen . On pelvic radiographs, there were no changes in number of seeds that had been implanted into the prostate between one day and two weeks after seed implantation. It was concluded that the seed had relocated from the right side of the middle abdomen to the left side of the middle abdomen. A subsequent abdominal CT demonstrated that the seed had migrated to the left kidney . In another patient , two weeks after seed implantation, an abdominal radiograph showed that two seeds had migrated to the same right kidney .

Figure 1

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