Prostate cancer is now the most commonly diagnosed cancer in men and is the second leading cause of cancer death in men, exceeded only by lung cancer, according to the American Cancer Society. The ACS estimates that 30,870 new cases will be diagnosed in America in 2007.
Radioactive implants offer men an effective treatment option for early prostate cancer that is less disruptive to their lives than standard treatment.
At the University of Wisconsin, a team including Radiation Oncologist Mark Ritter, M.D., Ph.D, Urologist Reginald Bruskewitz, M.D, Kim Brandt, RN and experienced Medical Physicists use brachytherapy or "seed" therapy for some prostate tumors. The team members are all members of the UW Comprehensive Cancer Center.
Unlike conventional radiation therapy using beams delivered from outside the body, the radiation sources in brachytherapy are smaller-than-rice-sized radioactive pellets which are inserted into the prostate. Between 80 and 100 pellets are placed, depending on the size of the prostate.
Patients leave the hospital the day of the implantation, but the radiation continues to act on tumor cells for several months, diminishing over time. Compared with conventional radiation therapy, brachytherapy delivers higher doses of radiation to the tumor and less to surrounding organs such as the bladder and rectum. It poses no risk to family members of the patient and patients can resume light activities within two to three days after the procedure and full activities after 1 - 2 weeks.
Physicians who have used prostate brachytherapy the longest-since the early 1990s-report that it stops tumor growth in about 80 to 95 percent of patients appropriate for the procedure. That success rate compares favorably with surgery or standard radiation therapy. In addition, brachytherapy patients report fewer side effects such as incontinence, impotence and rectal injury than patients receiving other treatments.
Once a prostate cancer diagnosis is confirmed, brachytherapy can be planned and performed in two hospital visits totaling about 10 hours, compared with 35 to 44 separate one-half hour visits for external beam radiation therapy or three days in the hospital for surgery to remove the prostate. The brachytherapy visits include a one-hour planning session in which ultrasound pictures (below) are taken to determine seed placement.
The prostate in highlighted in red and the rectum in green. A series of these images are taken in 5 mm steps starting at the top of the prostate (near the bladder) and finishing at the lowest part of the prostate. The planning computer software superimposes white dots that represent possible needle tracks and radioactive seed positions. Seed placement is planned so as to produce complete coverage of the prostate by an appropriate dose of radiation. Radiation coverage is indicated by the series of colored lines (isodose curves) around the prostate.
Just prior to the actual implant, multiple seeds (either as individual seeds or as strings of seeds) are loaded in hollow needles in accordance with the treatment plan as described above. These seed-containing needles are then loaded into a needle box (shown above) that is used to keep track of the 20-30 needles required for a given patient.
Ultrasound imaging is used to track placement of the radioactive seeds in the prostate during implantation. With the patient under either spinal or general anesthesia, needles are removed one by one from the needle box, are inserted through the appropriate template holes and are advanced until they are visualized in the appropriate place on the ultrasound image. The needle is then withdrawn, leaving behind a line of seeds in their planned positions within the prostate. The procedure itself takes less than two hours, with an additional 5-7 hours of recovery time required before the patient can leave the hospital.
Prostate brachytherapy works best on previously untreated, early stage tumors confined to the prostate-the stage at which an increasing percentage of prostate tumors are being discovered. Due to heightened surveillance with screening tests like the PSA (prostate specific antigen) and ultrasound imaging, many more men are being diagnosed with prostate cancer while it is still localized, or confined to the prostate. An estimated 60 percent of men with newly diagnosed, localized tumors would be eligible for brachytherapy.
Brachytherapy isn't appropriate for every man, but should be carefully considered alongside surgical removal of the prostate and external beam radiation therapy. Each treatment approach has its potential advantages and disadvantages and patients and physicians should carefully consider all options available to them.
This page discusses permanent radioactive prostate seed implantation. It tells you what will happen during the procedure.
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What is prostate seed implant?
Before the Implant
About 2-3 weeks before your implant procedure, a volume study will be performed in the radiotherapy department. This is used to determine the size of the prostate and for treatment planning. A rectal ultrasound probe is used to image the prostate and pictures will be taken to determine the number of seeds to use and their optimal locations within the prostate. It will be necessary to temporarily place a catheter into your bladder for the procedure. This appointment will take about one hour.
You will be given specific bowel preparation instructions. This is to aid in the visualization of the prostate gland.
After the volume study is completed, we will discuss the necessary tests that will be required for the implant. This will include blood work, possibly a chest x-ray and/or EKG. We will also make arrangements for you to see an anesthesiologist in the hospital. The anesthesia staff will discuss anesthesia options with you. Spinal anesthesia is most commonly used.
Day Before the Implant
You will be given specific bowel preparation instructions to follow again. Do not eat or drink anything after midnight the evening before the implant.
A nurse from the First Day Surgery Center will call you the day or evening before the procedure to review the instructions and to tell you what time to arrive at the hospital.
Day of the Implant
Please check in at the First Day Surgery Center located at B6/4 at the designated time. Leave your valuables such as jewelry and money at home or with a family member.
You will be asked to change into a gown. A nurse or anesthesiologist will meet you and start an intravenous (IV) infusion. You will wait in this area until it is time to do the implant. At that time you will be transported to the radiotherapy department. Your family and friends can come with you.
You will be taken into the procedure room where your doctors will be present. The anesthesiologist will start the spinal anesthesia. Special stockings are placed on each leg to assist with the circulation to your legs. A foley catheter is placed into your bladder. During the implant you will lie on your back with your legs elevated in stirrups. You will remain in this position until the implant is completed.
The scrotum is moved and taped out of the surgical area. The area to be implanted will be cleaned with betadine solution (anti-bacterial soap). Then, sterile sheets will be placed around the area.
Implant Procedure
The ultrasound probe is placed into the rectum to visualize the prostate gland again. When the probe is in proper position it will be secured to the table. Your doctor will place the needles, pre-filled with the radioactive seeds, into the prostate gland. Confirming the proper location of each needle by ultrasound, each needle will then be removed while leaving the seeds behind in the prostate. Fluoroscopy and x-ray will also be used to see the location of the seeds.
After the seeds are in place, your urologist may or may not examine the bladder. This is called cystoscopy. This scope looks into the bladder to determine if there any seeds in the bladder.
You will then be transported to the post anesthesia care unit (PACU) for further recovery. You will be discharged from the PACU to an inpatient room when you are fully recovered from the spinal anesthesia.
You will remain on the impatient unit until you are able to urinate without difficulty. Your radiation oncology doctor will discharge you from the hospital, generally on the same day.
After the Implant
This procedure generally does not require an overnight stay, but expect to be at the hospital for about 10-12 hours.
There may be some immediate side effects following your prostate implant. These may include: slight bleeding at the site of needle insertion, blood in the urine, bruising and tenderness at the scrotum and anal area. You will be given written instructions to manage these symptoms.
If you have any questions or concerns do not hesitate to call. Call the Radiotherapy clinic at 608-263-8500. If the clinic is closed your call will automatically be transferred to the answering service. They will put you in contact with the radiotherapy doctor on call.
If you would need to reach the First Day Surgery Center for any reason, the phone number is 608-265-8857.