Permanent Radioactive Seed Implant

The isotopes used for permanent seed implants are Iodine-125 or Palladium-103.

Measurement of the Prostate Gland

I.		The prostate gland is measured using a transrectal ultrasound probe. The size and shape of the prostate gland is recorded on film. The Radiation Oncologist and Medical Radiation Physicist determine how many seeds may be implanted and the desired strength (energy) for the seeds.
II.		When the prostate gland is larger than 40cc(gms), the Urologist or Radiation Oncologist will give Lupron, Casodex, Flutamide or Eulexin medication to block testosterone production. This will stop the tumor growth and decrease the size of the prostate gland. The medication is given once a month until the implant is performed.
III.		When the prostate gland is less than 40cc(gms), the radioactive material is ordered and the patient is scheduled for surgery following the initial ultrasound measurement.
IV.		Permanent seed implantation is performed in the surgery department on an outpatient basis. The patient is admitted the morning of the surgery and goes home that same evening.

Here are samples of the transrectal ultrasound films:

The prostate gland, in the transverse view, has been outlined for you in the film on the right. The films show a template grid overlying the prostate gland. The Radiation Oncologist and Urologist use this grid at the time of surgery to guide the hollow catheter/needles into place.

Implanting the Radioactive Seeds

The ultrasound probe is inserted into the rectum during surgery. Attached to the top of the probe is a template with holes to guide the insertion of the catheters into the prostate. These catheters hold the radioactive seeds and spacers to evenly separate the seeds.

This is a diagram of the B&K Ultrasound probe inserted in the rectum with the template attached to the probe:

The diagram above shows a single catheter through the template. Up to 19 catheters may be used during an implant. The average is 16 catheters. The diagram inset on the left highlights the radioactive seeds and spacers within the catheter. The other inset diagram on the right highlights the grid of the template. The entire prostate gland is embedded with catheters to predetermined locations.

Insertion of Radioactive Seeds

The radioactive seeds are loaded into hollow needles or catheters. These catheters are inserted into the template with ultrasound guidance.

With the use of the grid and the ultrasound guidance, all the catheters are inserted evenly covering the prostate gland and in some cases the seminal vesicles. Once all the catheters are in place, the short insert is removed and a longer one replaces it. The hollow needle is then pulled outward to meet the long insert, depositing the radioactive seeds within the patient’s prostate gland.

The catheters and the transrectal probe are then removed leaving all the radioactive seeds permanently in place within the prostate gland.

Cystoscopy Procedure follows Implant

Finally, the Urologist performs a cystoscopy procedure on the patient. This is the placement of a scope through the urethra into the bladder to assess the status of the bladder at the end of the implant and to remove any radioactive seeds that may be in the bladder. The patient may experience some blood in the urine immediately following the surgery. This is considered normal.

The patient goes home after leaving the recovery room and when he is able to urinate on his own. The patient will return to the Radiation Oncology Department one week after the implant for radiographic films to document and verify seed placement.

Short Term Side Effects

You may experience some short term effects of the radiation for the immediate month to month and a half following the implant. These may include burning upon urination, frequency in urination, the need to urinate at night, loose bowels, and/or diarrhea. You may also experience some discomfort in the bladder, rectum, and urethra commonly referred to as the "sunburn effect".

Long Term Effects

With the normal male aging process, men may develop impotence or urinary obstruction. The various treatments offered to patients with prostate cancer such as Surgery, External Radiation or Radioactive Implants, may hasten these problems.

Even though long term side effects are not common, they could appear after a period of three months to a year. As the prostate tumor cells are killed and the gland shrinks, urinary obstruction may be problematic. Scar tissue along the urethra may account for narrowing of the passage of urine from the bladder. Other more severe side effects include rectal injury, rectal-urethral fistula, rectal-vesicle fistula and in the worst situations, even lead to a colostomy. Again, these problems are unusual, but you should be aware of them.

Special Note:

The sequence of events and the individual events outlined in the above document are used by Dr. Tokita and Dr. Horns in their treatment of the prostate gland using external beam radiation. If you have other resources that differ with this information, please keep in mind that there are multiple methods of treating this cancer and this is what we have found to be the best for our patients.