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Treatment of prostate cancer presents a dilemma. On the one hand, many patients do not actually need treatment because their cancer is growing so slowly and they may be advised to actively monitor the cancer with frequent testing. However, prostate cancer is the second most common cause of cancer death in men. With appropriate testing, a specialist doctor can reasonably predict how a cancer may behave, but there is no fool-proof way to detect how aggressive a cancer will become in any specific patient. This is why most men choose some type of treatment for early stage prostate cancer.

Because the seed implant is a same day procedure that is significantly less traumatic than surgery. It is also not associated with the degree of unpleasant long term side effects and complications that can occur with surgery and external beam radiation. It therefore may be the best treatment option depending on your age, general health and the stage of the cancer.

Studies have shown that brachytherapy is at least equally effective at treating prostate cancer in properly selected patients with low and intermediate risk disease when compared to surgery (radical prostatectomy) and external beam radiotherapy. Moreover, studies have shown that patients generally experience fewer long term serious side effects after brachytherapy, especially urinary incontinence and erectile dysfunction, when compared with the other established treatment options. For later stages and very aggressive prostate cancers, more than one type of treatment may be given. For instance, brachytherapy can be used in combination with external beam radiotherapy (EBRT). This can help improve the overall effectiveness of the radiotherapy and limit the side effects from a larger external radiotherapy dose if given alone.

LDR Brachytherapy is most suitable for patients who fall into the category of low or intermediate-risk with cancer confined to the prostate. The selection criteria for this group of patients is a Gleason score equal to or less than 7 and an initial PSA value lower than 20ng/ml.

All treatments for prostate cancer carry a risk of side effects. Side effects of brachytherapy is usually experienced in the initial weeks after the implant when the seeds are most active and usually subsides by one year. The most common side effects during the early period can include problems with passing urine, and mild worsening of erectile dysfunction. Generally there are no issues with urinary incontinence which is very common with surgery. Note that most patients reported mainly mild side effects that subsided to normal with time.

No, brachytherapy is generally provided as a same day procedure.

Treatment is carried out under general anaesthesia and you will not feel pain. However, after treatment you may experience tenderness or discomfort in the perineum where the needles were inserted. This is usually mild and may ease up the next day. Your doctor may prescribe over the counter pain relief medications.

Brachytherapy is a non-surgical procedure and no incision is made. There is minimal or no blood loss and therefore no blood transfusion is needed.

Urinary retention (being unable to empty your bladder) may occur after treatment and you may require the insertion of a urinary catheter to empty the bladder. This is not a common side effect and may be caused by irritation of the ureter and the prostate by the radioactive seeds, resulting in swelling of the prostate. Once the swelling reduces, the catheter is removed. You will be given more advice about this if you need to have a catheter in place prior to discharge home.

You can resume normal activities depending on how strenuous the activities are and how you react to the implant. Most men are usually ready to return to their regular activities within 3-5 days after the procedure. However, the lifting of heavy objects of more than 10-15 pounds must be avoided for the first two weeks following the procedure to prevent any bleeding or movement of seeds

Seed implants are radioactive and remain in the prostate permanently. The radiation levels emitted by the seeds is of such low energy, it dissipates before reaching the patient’s skin. It gradually decreases over time and after 10-12 months the seeds become inactive. It is safe to sleep in the same bed as your partner. You will not have to do anything special with linens, clothing, dishes, or in the bathroom. The seeds won’t disturb pacemakers or microwave ovens.

To be extra safe, children and pregnant women should not sit on your lap two to three months after treatment. You may greet them and remain in the same room as you normally would. However, it is advisable they maintain a distance of three feet away from you.

It is safe for you and your partner to have sex two weeks after your seed implant. It is advised to use a condom on the first few occasions as there is a small chance a seed may pass out when you ejaculate. You will be given instructions on what to do if this occurs

A CT scan is performed after the seed implant to document precisely where the seeds have settled in the prostate and this is used to calculate the exact radiation dose to the prostate. These results are compared with the pre-implant dosimetry plan. This provides the Urologist with the confirmation, the prescribed dose was delivered to the prostate. This is the final step in every seed implant.

No. The seeds are made of titanium, similar to the material developed for pins or clips used in medical procedures. There should be no problem with security systems or metal detectors

Yes, it is safe to have a colonoscopy, however, we recommend waiting 6 months after the seed implant before having a colonoscopy. You should always inform the doctor performing the colonoscopy that you have had a prostate seed implant.

Your PSA level is a good indicator of how effective treatment has been. Following LDR brachytherapy, your PSA value should slowly decline and then stabilize over time. Some men may experience a temporary increase in PSA levels by 2ng/ml or more which is referred to as a PSA 'bounce' or 'spike.' This may occur during the first year and up to three years after treatment. The PSA bounce is not a sign of treatment failure. The normal course of action would be for your doctor to repeat the PSA in 2 to 3 months. Your doctor will evaluate any additional data in conjunction with the PSA to monitor your treatment outcome.

The need for additional treatment is determined by the PSA level. Regular post-treatment PSA evaluation plays an important role in monitoring and evaluating the need, if any, for additional treatment in the future. Should the cancer reoccur, options for treatment will in part depend upon the initial treatment. Additional or alternative forms of radiation therapy for example external beam radiation therapy or hormone therapy may be recommended. Your urologist will discuss these treatment options with you.


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