For many men with prostate cancer, seed treatment is an appealing choice. The side effects ar eminial and the recovery time is much shorter than other forms of surgery.
However, as appealing as this treatment may sound, it is not suitable for everyone.
We have compiled some basic information on the procedure to help you. As with any medical decision, be sure to consult your physician before choosing to undergo this procedure.
What is Prostate Cancer Seed Treatment?
Prostate cancer seed treatment, also known as brachytherapy, is a form of radiation treatment for prostate cancer. ¹
Also known as internal radiation therapy, a CT scan is used to guide small radioactive pellets into the prostate gland. These pellets slowly give off high doses of radiation, which targets and kills cancer cells with minimal damage to the surrounding tissue.
There are two forms of this type of therapy:
- Low dose rate brachytherapy (LDR): in which the seeds remain in the prostate gland permanently, and give off low doses of radiation. This radiation becomes inactive after a few months.
- High dose brachytherapy (HDR): hollow catheters are inserted into the prostate gland. The seeds, filled with radioactive iridium, are implanted into the cancerous tissue, where they give off high doses of radiation over a period of time. HDR brachytherapy lasts fifteen minutes, and is repeated 2-3 times over the course of a few days. ²
Who is eligible for this kind of surgery?
Brachytherapy, while effective, is not a treatment option for all men with prostate cancer.
Because the seeds have limits to how far they can penetrate the tissue, this form of therapy is only recommended for men who have low grade, non-metastasized cancer.
Additionally, this type of procedure should not be performed on men who have lower urinary tract issues. The prostate gland typically swells after this type of procedure, which could further irritate urinary tract symptoms.³
In men with immediate risk cancer, internal beam radiation can be used in combination with external beam therapy as an effective form of treatment.
Prepping for the surgery
A few weeks before the surgery, your doctor will conduct a volume study to measure the size and position of your prostate gland. This study uses sound waves to create images of the prostate gland, allowing the doctor to assess how many seeds to implant. This prep typically takes 30 minutes to an hour. ⁴
A few weeks prior to the procedure, your doctor will ask you a series of questions regarding your medical history. It is important to be honest with your answers to ensure a successful procedure with few side effects. Your doctor will want to know the following:
- Are you allergic to any medications? If so, what kinds of reactions to you exhibit?
- Have you had colon, prostate, bladder or rectal surgery in the past?
- Do you have a history of – or have you exhibited any warning signs of – heart disease?
- A list of your medical conditions, including: diabetes, kidney issues or bladder problems.
- A list of medications you are currently taking, particularly blood thinning medications.⁵
On the day of surgery, you will be placed under general or spinal anesthesia. The doctor will elevate and pad your legs before inserting an ultrasound probe into the rectum. This ultrasound probe takes photos of the prostate and will remain in place throughout the procedure. In some cases, a CT scan or MRI will be used alongside the ultrasound probe to accurately guide the implants.
The seeds are then loaded into long, thin needles and inserted into the area between the anus and scrotum, also known as the perineum. Once the placement of the needle is confirmed, the seeds are released and implanted into the prostate tissue. ⁶
The whole procedure will take roughly 90 minutes and is performed as an outpatient procedure.
Frequently Asked Questions
- Is the radiation harmful? The seeds that are implanted contain radioactive iodine-125 or palladium-103. In large doses these elements are harmful; however, because brachytherapy seeds are so small – roughly smaller than a dime – and are specifically placed within cancerous tissue, there is no long-term risk of radiation exposure. ⁷
- Will the metal in the seeds set off security detectors? Brachytherapy seeds are covered by titanium shells, which typically causes no allergic reactions in patients. Due to their extremely tiny size, location and titanium covering, brachytherapy seeds will not set off metal detectors.
- How long does the procedure take? Part of the reason internal beam therapy is so appealing is its convenience. External beam radiation therapy is typically performed over the course of 5-7 weeks, but brachytherapy treatment can be completed in 2-3 days, not counting post-surgical follow-ups. Each session lasts for about an hour to 90 minutes.
- What is the recovery time? This procedure is minimally invasive and, as a result, requires less recovery time. Most patients are able to return to work and normal activities roughly 3 days after treatment.
- Are there any side effects? As with any form of treatment, brachytherapy comes with side effects. Swelling of the prostate can cause the urge to frequently urinate, urinary urgency, burning and an inability to fully empty the bladder. Urinary incontinence in men is rare, but the likelyhood of this side effect increases in patients who have undergone surgery to remove a portion of their prostate, also known as transurethral resection of the prostate.
- Do I need to worry about impotence? After 5 years, 25 to 35 percent of men will experience impotence. This risk for this side effect increases with the use of other treatments, such as hormone therapy, but is still 10% less likely to occur than with external beam radiation therapy or nerve-sparing radical prostatectomy surgery. The good news is that impotence can be treated with medication. ⁸
- American Brachytherapy Society (ABS): About Brachytherapy. (2015, January 1). http://www.americanbrachytherapy.org/aboutbrachytherapy/qanda.cfm#8
- Brachytherapy (Radioactive Seed Implantation Therapy) in Prostate Cancer . (2013, October 23). http://emedicine.medscape.com/article/453349-overview
- Castle, E. (2014, June 9). Prostate cancer. http://www.mayoclinic.org/diseases-conditions/prostate-cancer/expert-answers/prostate-cancer-brachytherapy/faq-20058023
- Johns Hopkins – Brady Urological Institute- Prostate Cancer Update. (2000, January 1). http://urology.jhu.edu/newsletter/prostate_cancer56.php
- Prostate Cancer Radioactive Seed Implants – WebMD. (2013, August 3). http://www.webmd.com/prostate-cancer/radioactive-seed-implants?page=3
- Information for Families and Patients. (2014). In Radioactive Seed Implants for Prostate Cancer (p. 9). St. Louis: The Alvin J Siteman Cancer Center, http://radonc.wustl.edu/pdf/prostateseed.pdf.
- Smilow Comprehensive Prostate Cancer Center. (2014, January 1). http://prostate-cancer.med.nyu.edu/faqs/faqs-radition-therapy
- Urology Care Foundation The Official Foundation of the American Urological Association. (2013, April 1). http://www.urologyhealth.org/urology/index.cfm?article=17