Short Course ext beam

Prostate Cancer Treatment Option

Short Course External Beam Radiation

Combined With

Permanent Radioactive Seed Implant

The radioisotope used for combined external beam radiation and seed implant is Palladium-103 or Iodine-125. The external beam radiation supplements the seed implant when an area larger than just the prostate gland needs to be irradiated. This allows the Radiation Oncologist to deliver a dose to the seminal vesicles and pelvis to the pelvic side-walls surrounding the prostate gland.

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. A computer plan is run to determine the desired dose distribution.

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 hormone shot is given once a month and the medication is taken daily until the external beam radiation is started.

III. When the external beam radiation is completed, another transrectal ultrasound exam is performed to measure the gland prior to the implantation of the radioactive seeds.

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 catheter/needles into place. More information on the surgical procedure will follow.

When does the External Beam Radiation begin?

You will need to schedule an appointment with the radiation oncology department.

I. You will first be scheduled by the Radiation Oncology Department for a planning CT scan.

II. The following day you will be scheduled for a simulation. This is the process in which the therapist takes you into an X-Ray room and localizes the area to be irradiated. The therapist will ask you to drink some barium in order to identify your small bowel on X-Ray.

III. The therapist will be making marks on your skin with a felt tip pen to "map" out the area to be treated. Films will be taken.

IV. You will be scheduled to return the next day or so to begin treatment. The first day in the treatment room, X-ray films called port films will be taken to verify once again that the area "mapped" out is the area that is being targeted for treatment.

V. Your treatments will be scheduled Monday through Friday for approximately 5 weeks. This means you will make approximately 23 to 25 visits to see us for treatment.

When is the surgery scheduled?

Approximately 2 - 4 weeks following your external beam radiation course, your surgery will be scheduled.

What happens on the day of surgery?

I. The patient arrives in the Ambulatory Surgery Unit (ASU) and is admitted for the surgery.

II. The implant is performed in the surgery department by your Urologist and the Radiation Oncologist.

III. After the surgical procedure of inserting the radioactive pellets is completed, you are taken to the recovery room.

IV. You are released from the recovery room when you are able to urinate on your own. Then you will be allowed to go home. You will need someone to drive you home.

Surgical Procedure

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 will hold the radioactive seeds to evenly separate them.

Below 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 cathethers 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 placement of the radioactive seeds.

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 a permanent seed implant and 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.

Copyright © 2004 Cancer Center of Irvine. All rights reserved Disclaimer

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. A computer plan is run to determine the desired dose distribution.
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 hormone shot is given once a month and the medication is taken daily until the external beam radiation is started.
III.		When the external beam radiation is completed, another transrectal ultrasound exam is performed to measure the gland prior to the implantation of the radioactive seeds.

I.		You will first be scheduled by the Radiation Oncology Department for a planning CT scan.
II.		The following day you will be scheduled for a simulation. This is the process in which the therapist takes you into an X-Ray room and localizes the area to be irradiated. The therapist will ask you to drink some barium in order to identify your small bowel on X-Ray.
III.		The therapist will be making marks on your skin with a felt tip pen to "map" out the area to be treated. Films will be taken.
IV.		You will be scheduled to return the next day or so to begin treatment. The first day in the treatment room, X-ray films called port films will be taken to verify once again that the area "mapped" out is the area that is being targeted for treatment.
V.		Your treatments will be scheduled Monday through Friday for approximately 5 weeks. This means you will make approximately 23 to 25 visits to see us for treatment.

I.		The patient arrives in the Ambulatory Surgery Unit (ASU) and is admitted for the surgery.
II.		The implant is performed in the surgery department by your Urologist and the Radiation Oncologist.
III.		After the surgical procedure of inserting the radioactive pellets is completed, you are taken to the recovery room.
IV.		You are released from the recovery room when you are able to urinate on your own. Then you will be allowed to go home. You will need someone to drive you home.