PROSTATE BRACHYTHERAPY PERMANENT RADIOACTIVE SEED IMPLANT: A Non-Surgical alternative
Currently, there are several treatment modalities performed by the Urologist which are available for early stage prostate cancer. One of the least invasive or non-surgical is Permanent Radioactive Seed Implantation or brachytherapy. This is a minimally invasive procedure that obviates the need for a prolonged and extensive surgery while achieving comparable long-term cure rate as compared to radical prostatectomy. Iodine 125 radioactive seeds are utilized which produce low dose radioactive energy with known focused area of activity in the appropriate dose which kills the prostate tumor cells leaving the rest of the body unaffected.
Iodine 125 seed consumes 90% of their radioactivity in less than a year wherein therapy is completed. There is minimal radioactivity beyond the patient and to other persons nearby. The permanent Iodine 125 seeds are about the size of a grain of rice. Typically the number of seeds may range from 50 to the size of the prostate as determined by a preliminary volume study.
The prostate gland is treated entirely to provide a treatment uniform dose to ensure other involved areas of the gland not detected before are treated. adequately. Prior to the treatment itself, the patient undergoes the prostate volume study which is guided with a transrectal ultrasound machine. This enable the urologist to make a map of the prostate gland to accurately determine the number of seeds needed to treat the tumor therefore ensuring an accurate location for seed implantation.
The patient shall be given prior dietary restrictions and shall undergo bowel preparations. This will ensure that the rectum will be clear to allow visibility of the prostate during the procedure.
The patient will undergo cardio-pulmonary clearance prior to the procedure. Laboratory tests are done to evaluate the patient’s surgical risk to undergo the procedure under spinal anesthesia.
The patient shall discontinue blood thinners such as aspirins and the like at least one week prior to the seed implantation.
Thin needles are inserted into the prostate gland through the skin of the perineum (between the scrotum and the rectum) without any surgical incisions. The procedure is done in the operating room under spinal anesthesia so that it will be a pain-free experience. To ensure proper placement of the needles in conformity to that obtained from the planning, transrectal ultrasound guidance is again utilized. When the exact location of the needle has been ascertained, the seeds will then be deposited into the prostate gland, while the needle is being removed.
Finally a urinary catheter will be placed temporarily into the bladder to allow urine drainage and irrigation for about 24 hours until the patient is discharged the day after. The patient will be brought to the recovery room for about one to two hours. The patient may then resume their usual regular diets. Slight discomfort is experienced by the patients which are relived by oral pain medications. Bloody urine is expected and usually clears within 72 hours. If bleeding and pain persists or fever develops and become more pronounced, the patient should contact their attending urologist.