Brachytherapy is an effective treatment for patients who have early prostate cancer. It is also an attractive option for patients whose poor health suggests that a radical prostatectomy surgery should be avoided. When a patient's cancer has spread out beyond the prostate gland, a combination of external radiation and seed implantation provides one of the most effective treatments.

Prostate brachytherapy (seed implantation) is an alternative for men who have early stage prostate cancer (cancer that has not spread outside the prostate gland.) Seed implantation is also an attractive option for men whose poor health precludes radical surgery, or who may be unable to undergo 35-40 daily excursions for external beam radiation therapy. The procedure performed properly; seeds are implanted with pinpoint accuracy; they pose minimal risk to surrounding organs or tissue.

Seed implantation is a viable option for early prostate cancer. You should speak with your doctor to determine if this is an option for you.

This procedure is an alternative for men who have early-stage prostate cancer. Seed implant alone is used for patients who have a low risk of disease outside the gland. External beam radiation plus seed implantation is used in situations in which there is a greater risk of disease outside the prostate. Seed implantation is also an attractive option for men whose poor health precludes radical prostatectomy.

The value of a biopsy after seed implantation is controversial. This is primarily because of the lack of skilled pathologists interpreting the biopsies and the discomfort associated with the procedure. There is also the suggestion that the biopsy may give no better information than the PSA in predicting success of the treatment. Radiation can cause prostate cancer cells to appear quite abnormal. This has been particularly noted if the biopsy is done before two years.

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No. Although the seeds are radioactive, patients are not. Because the radioactivity is so low and the placement is so precise, virtually all the radioactivity is absorbed into the prostate. However, special precautions should be taken when a patient is in contact with small children and pregnant women in the first two months after treatment. You nurse or doctor will advise you what precautions are necessary and when. No, the seeds are of low energy and pose little risk to your partner.

Prostate seed implantation is usually performed in an outpatient hospital setting by a urologist and/or radiation oncologist.

There is much opinion and little information to help decide the appropriate regimen of CHB prior to seed implantation. Our regimen has followed the EBRT and CHB trials that gave CHB for at least two months prior to seed implantation. Patients receiving combined EBRT and seeds receive CHB until the day of the implant. While our regimen stops the CHB the day of the implant, we see no harm in continuing the CHB after implant.

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The risk of long-term incontinence after either seed implant alone or in combination with external beam radiation in the typical, (non-TURP), patient is extremely rare, less than 1%. Over the short term, some patients experience significant urgency and may have difficulty reaching the restroom without some slight dribbling. This resolves over one to two months. In patients with a large TURP defect, it is technically challenging to perform a good implant.

All men who are candidates for a radical prostatectomy may be candidates for a seed implant alone, if they have stage A or stage B disease. Men who are not candidates for a prostatectomy because of a health reasons and may be poor anesthesia risks, may be candidates for seed implantation because of its low anesthesia risk. Occasionally, a patient may require external radiation therapy prior to the seed implant if they have advanced disease or markedly elevated PSA.

Since the seeds are implanted in the prostate with pinpoint accuracy, they pose little risk to nearby, non-cancerous tissues. The result is a low complication rate with seed implants for incontinence or impotence.

Although the early use of hormone therapy has not been studied In the case of brachytherapy, it appears to increase the effectiveness of external beam therapy. Consequently, it may also prove effective in brachytherapy. However, because of the side effects of the hormones, they should probably not be used in low-risk patients.

The first visit is at 6-8 weeks and thereafter every three months for two years. After two years, visits are recommended every six months. After five years, a PSA is scheduled every six months and a physical exam at least once a year. Alternating these visits between the radiation oncologist and urologist insures complete care. If the patient has a good internist or family practitioner, we encourage his/her participation as well.

No. Although the seeds are radioactive, patients are not. Because the radioactivity is so low and the placement is so precise, virtually all the radioactivity is absorbed into the prostate. Patients are recommended to avoid prolonged close contact with small children and pregnant women in the first two months after treatment.

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The patient needs to fast 4 hours prior to the procedure. If the patient’s heart rate is greater than 65 BPM then medication may be administered prior to the exam to slow the heart rate.

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Dr. Gottesman began doing permanent seed implantation through the open approach over twenty years ago. He and Dr. Mate have been performing temporary HDR implants since 1989. Drs Blasko and Grimm pioneered the development of transperineal seed implantation at Northwest Hospital with Dr. Ragde in 1986. Dr. Sylvester has been performing seed implantation since 1987.

In some patients, the presence of a previous TURP prevents a technically good implant. In the past, patients with a prior TURP had an increased risk of urinary incontinence of approximately 25% at six years. The majority of this incontinence was minor, requiring a simple pad. In the past several years changes in the pattern of seed placement have been done in these TURP patients with the hope of decreasing this risk.

Complication rates with radioactive seed implants are less than those of radical prostatectomy or external beam radiation. After a radioactive seed implant, less than one percent of patients who have not had prior surgery will become incontinent, and about 15 percent of the men treated under the age of 70 will become impotent. In men older than 70 the impotence rate is usually higher.