The following is the information shared with a typical patient for what to expect after their procedure.

After your procedure

• You will remain in the theatre recovery area for a short period of time before being transferred to the ward.
• You may have an ice pack placed between your legs to help reduce swelling to the implant area.
• Advise the healthcare team if you are experiencing pain. They can help manage this by giving you pain killers if necessary.
• You can resume eating and drinking once you are awake.

Preparing to go home

• You will need to pass urine.
• You will be given antibiotics to prevent infection.
• You may be given a stool softener to avoid constipation.
• You will be given a sieve through which to urinate for the first few days and a lead container that you can place a seed in. The TTPB team will instruct you on what to do if you “pass” any seeds.

When should I call my Doctor?

It is expected you will experience some degree of discomfort and swelling around the perineum (area between the anus and the base of the scrotum) after seed implant but this should improve as the days go by. Call your doctor right away if you:

• Have increasing pain around the treatment site that pain medication does not take away.
• Notice an increase in swelling in your scrotum.
• You have a temperature or fever of more than 100.5°F or 38°C
• Pain in your back or abdomen
• Are unable to pass urine.

Side Effects post LDR Brachytherapy

LDR Brachytherapy may cause some side effects and vary in severity among patients. These side effects are caused by the needles used to place the seeds and the radiation coming from the seeds which start off at its strongest after the implant and reduce to unmeasurably low levels by 10-12 months. The typical symptoms experienced by patients after LDR Brachytherapy are described in the sections below.

Urinary side effects

In most cases these urinary side effects may be moderate and resolve within a few weeks. However, in a small percentage of patients, symptoms may last a few months and may include burning, urgency, frequency, discomfort and a slower stream particularly at night. Talk to your urologist as there is medication available to make you more comfortable.

Note that some foods and liquids may irritate the bladder and prostate. It is advisable to drink 2-3 litres of water a day and to avoid caffeinated drinks.

Bowel side effects

The rectum is close to the prostate and permanent seed implant can irritate the lining of the rectum which may cause problems. The risk of rectal and bowel problems after permanent seed brachytherapy is low. However, avoid constipation by eating a well-balanced nutritious diet including vegetables, fruit and foods high in fibre as this will keep bowel movements regular and soft.

Erectile Dysfunction

Some patients may experience erectile dysfunction. Talk to your Urologist as this may be due to radiation from the seeds. Prescription medication has shown to be effective in restoring erectile function.

Sexual activity

Sexual activity may be resumed 2 weeks after your implant and a condom must be used for the first 2 ejaculations, as there is a small chance a seed may pass out when you ejaculate. You will be advised on what to do if this occurs. You may also observe that your semen (fluid that is released out of your penis during orgasm) may be discoloured or blood stained. This is normal and comes from the slight bleeding which may have occurred where the needles were positioned to implant the seeds. You may also experience pain on ejaculation as the prostate contracts with orgasm. These are short term side effects and will resolve over time.

Before admission to hospital

The following are the instructions given to a patient so as to give you a better idea of the steps involved in the treatment.

You will be advised by the TTPB team:

• How to prepare your lower bowel (rectum) for the procedure including diet and possibly an enema.
• Fasting time (when to stop eating and drinking before your procedure)
• Medication, X-Rays, scans that you are required to bring with you
• Medication you need to stop before the procedure, e.g. anti-coagulants, anti-inflammatories, herbal or complimentary supplements

Admission to hospital

The preparation for your procedure may include the following:

• Hospital admission paperwork to be completed with administration staff.
• Changing into a patient gown that has to be worn for the procedure.
• Removing jewellery, glasses and dentures.
• You will have an opportunity to discuss any concerns with your Urologist, Anaesthetist or member of the TTPB team.

Transrectal Ultrasound Prostate Volume Study

The first stage of prostate brachytherapy is a transrectal ultrasound (TRUS) prostate volume study. This planning process is done a few weeks prior to the seed implant. Information from the ultrasound about the size, shape and volume of your prostate will be used to develop your cancer treatment plan.

The volume study takes about 30 to 45 minutes. Since ultrasound images are produced by sound waves bouncing off the structure to create the image, you will usually be asked to use some type of laxative and or enema prior to this study to clean out your rectum.

These pictures or images will be placed into a computer program to map the prostate and associated critical structures, such as the rectum, to create a seed implant plan for the day of your procedure. The implant plan will show the number and location of needle placement required for the seeds to be implanted, as well as measurements for placement of the radioactive seeds within the prostate. You can drive yourself for the volume study procedure.

How is Brachytherapy done?

In LDR Brachytherapy, small radioactive seeds are non-surgically implanted into the prostate, usually under general or spinal anaesthesia, in the operating room. The radioactive seeds are tiny, silvery colour, and rice-like in size. Multiple seeds can be inserted through a single needle in different locations within your prostate to provide radiation coverage for the entire prostate area. Once you are given anaesthesia, your legs will be placed in stirrups or leg holders to position you for the procedure.

A urinary catheter (tube inserted into the bladder to drain urine out) will be inserted. The rectal ultrasound probe (same equipment used for your volume study) will be inserted into your rectum. This will produce a picture of your prostate on the ultrasound screen so the physician will know exactly where to insert the needles. The rectal probe will be attached to a stand and a grid with holes in it and placed against your perineum (the skin behind the scrotal area and above the rectum).

The grid has letters of the alphabet on the top and numbers down the side. Once the rectal probe is placed, the ultrasound screen will have a grid matching the template against your perineum to guide the needle placement into your prostate. Your seed implant plan developed from the volume study will tell the physician where to place the needles directly into your prostate. The physician will first place the hollow needles through the perineum into the prostate gland and then insert a very thin instrument through the needles placing the radioactive seeds into your prostate. Once all the seeds are placed, the needles are removed, and pressure will be applied to your skin. You will not have a dressing to this area or stitches, since no incisions are made.