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High-Dose-Rate Brachytherapy for the Treatment of Prostate Cancer

This guide will help you prepare for your high-dose rate brachytherapy treatment at Memorial Sloan Kettering Cancer Center (MSK).

Prostate cancer is the most common cancer diagnosed in men in the United States. New methods of treatment cause fewer side effects than older methods. These treatments have excellent survival rates. Depending on the stage of disease and your general health, you may be able to choose the treatment you prefer.

Radiation therapy may be used to treat prostate cancer. Radiation therapy kills cancers cells with high energy rays.

One way to give radiation is to place a radioactive implant inside the body. The implant is placed in or near the tumor. This is called brachytherapy (brak-e-ther-ah-pe). You will be getting high-dose rate brachytherapy (HDR) delivered through a system of catheters (a small, flexible tube). These catheters will be placed in the operating room.

The prostate gland lies next to the inner wall of the rectum, below the bladder (see Figure 1). When you are lying on your back with your legs raised your prostate gland lies directly behind your perineum.

The prostate gland is a small, firm gland about the size of a walnut. It lies next to the rectum, directly below the bladder. The prostate makes and secretes semen.

The urethra is the tube that carries that carries urine from the bladder out through the penis

Seminal vesicles are small glands near the prostate that produce the fluid in semen.

The perineum is the space between your scrotum and anus

Procedure Steps

You will be taken into the operating room and be positioned on your back with your legs raised. A small probe that produces an image of your prostate on a video screen will be placed into your rectum. Your doctor will use this image to help guide the insertion of the 12 to 22 catheters into your prostate gland. The catheters will be held in place by a template. The template is a small square piece of plastic with many holes in it and will be secured with sutures between your legs, just below your scrotum (see Figure 2).

After the catheters are in place, your urologist will do a cystoscopy and a computed tomography (CT) scan to ensure that your catheters are positioned correctly.

For Your Safety

At MSK, we want to keep you safe during your procedure. You can help by telling us if any statements apply to you, even if you aren't sure.

  • I take a blood thinner, such as heparin, warfarin (Coumadin®), clopidogrel (Plavix®), or tinzaparin (Innohep®).
  • I take any prescription medications.
  • I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker or other heart device.
  • I smoke.
  • I have ever had a problem with anesthesia.
  • I have allergies, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I have sleep apnea.
  • I use recreational drugs.

Drinking alcohol

The amount of alcohol you drink can affect you during and after your procedure. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.

  • Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are risk for these complications, we can prescribe medication to help prevent them.
  • If you drink alcohol regularly, you may be at risk for other complications during and after your procedure. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.

Here are things you can do to prevent problems before your procedure:

  • Be honest with your healthcare provider about how much alcohol you drink.
  • Try to stop drinking alcohol once your procedure is planned. If you develop a headache, nausea, increased anxiety, or can't sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can't stop drinking.
  • Ask us any questions you have about drinking and procedure. As always, all of your treatment information will be kept confidential.

Smoking

People who smoke can have breathing problems when they have procedure. Stopping even for a few days before procedure can help. If you currently smoke or recently quit smoking, you will be referred to the Tobacco Treatment Program by your surgeon. You will receive a call from a nurse at the program, or you may contact the program at (212) 610-0579.

Sleep apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems after procedure. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your procedure.

Preparing for Your Procedure

Within 30 days of your procedure

Presurgical testing (PST)

During your PST appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will give you medication to sleep during your procedure). You can eat and take your usual medications the day of your PST appointment. During your appointment, your nurse practitioner will review your medical and surgical history with you, including your medications. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers. It is very helpful if you bring the following with you to your PST appointment:

  • Medication list
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study
  • The name(s) and telephone number(s) of your doctor(s)

The PST clinic is located in the Rockefeller Outpatient Pavilion, also known as MSK 53rd Street.

Rockefeller Outpatient Pavilion
160 East 53rd Street
(at Third Avenue)
New York, NY 10022
 

Parking

The Bristol Garage offers discounted parking to patients. To receive the discount, patients and visitors must have their parking ticket validated at the concierge desk in the Rockefeller Outpatient Pavilion. Shuttle service is provided from Bristol Garage to the Rockefeller Outpatient Pavilion every 20 minutes.

The Bristol Garage
300 East 56th Street
(Between First and Second Avenues)
New York, NY 10022
 

Several additional parking garages are also located nearby:

East 53rd Street between Second and Third Avenues (2 garages available)
East 54th Street between Second and Third Avenues
 

Health care proxy

If you haven't already completed a health care proxy form, it's a good idea to complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a health care proxy form, talk with your nurse. If you have already completed a health care proxy form or if you have any other advanced directive, bring it with you to your next appointment.

Exercise

Walk every day. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your procedure and make your recovery faster and easier.

Eat a healthy diet

You should eat a well-balanced, healthy diet before your procedure. If you need help with your diet, talk to your doctor or nurse about meeting with a dietitian.

Stop drinking alcohol

Try to stop drinking alcohol once your procedure is planned. If you develop a headache, nausea, increased anxiety, or can't sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.

10 days before your procedure

Medications

Stop taking aspirin, medications that contain aspirin, and vitamin E. These medications can cause bleeding. You will get a fact card called Common Medicines Containing Aspirin and Nonsteroidal Anti-Inflammatory Products to review.

Purchase supplies

Purchase the bowel preparation kit your doctor instructed you to use if you haven't already done so. Most patients will use the HalfLytely® Bowel Prep Kit. The kit is available at any pharmacy with a prescription from your doctor, and includes:

  • One 5 mg tablet of bisacodyl
  • HalfLytely® powder in a 64 ounce bottle
  • Flavor packets

This is also a good time to stock up on clear liquids to drink the day before your procedure.

7 days before your procedure

Herbal remedies

Stop taking all herbal remedies. You will get a fact card called Herbal Remedies and Cancer Treatment to review.

2 days before your procedure

Medications

Stop taking all nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding.

1 day before your procedure

You may have solid food for breakfast. Try to finish your breakfast by 10:00 am. After breakfast, start the clear liquid diet outlined below.

Prepare your HalfLytely® bowel preparation

Follow our instructions. Do not follow the instructions on the HalfLytely® box. Do not take other laxatives or more than the dosage given below. Serious side effects can occur.

Mix the HalfLytely® solution as follows:

  • Add lukewarm drinking water to the top of the line on bottle
  • Add a flavor packet provided with the HalfLytely® kit
  • Cap the bottle and shake it until the powder is dissolved. The mixed solution will be clear and colorless even if you added a flavor packet

Put the mixed solution in the refrigerator; patients have told us that it tastes better chilled. Do not mix the HalfLytely® earlier than the morning before your procedure.

  • Drink at least one 8 ounce glass every hour after breakfast. Have only clear liquids.
  • Do not drink anything that is red or purple in color.
  • Do not drink alcohol.
  • Limit caffeinated beverages to 2 cups.
  • Do not drink diet liquids, even if you are a diabetic. You will become weak and dizzy if you just drink water or low-calorie drinks.

At 3:00 pm, take the bisacodyl tablet by mouth with a glass of water.

Take your HalfLytely® bowel preparation

At 5:00 pm, drink one 8 ounce glass of the HalfLytely® solution every 15 minutes. You will drink all of the solution, for a total of about 8 glasses.

  • You must try to finish the entire bottle of HalfLytely®. If you feel bloated, drink one 8 ounce glass of HalfLytely® every 20 minutes. If you have nausea and vomiting, wait about 30 minutes, then try to resume drinking the HalfLytely®.
  • Bowel movements usually begin within 1 hour of drinking the first dose of HalfLytely®, but it takes longer for some people.
  • Apply petroleum jelly (Vaseline®) or A & D® ointment to the skin around your anus after every bowel movement. This helps prevent irritation.
  • You may continue to drink clear liquids until midnight, but it is not required.

Clear liquid diet

 

Drink

Avoid

Soups

  • Clear broth or bouillon
  • Clear consommé
  • Clear packaged vegetable, chicken, or beef broth-mix
  • Any products with any particles of dried food or seasoning

Sweets

  • Gelatin (such as Jello®)
  • Flavored ices
  • Anything red or purple

Beverages

  • Clear fruit juices, such as white cranberry, white grape, apple
  • Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, Gatorade®
  • Black coffee (no cream)
  • Tea
  • Juice with pulp
  • Nectars
  • Milk
  • Alcoholic beverages

Presurgical phone call

A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure.

He or she will tell you what time you should arrive at the hospital for your procedure. If you are scheduled for a procedure on a Monday you will be called on Friday. If you do not receive a call by 7:00 pm the evening before your procedure, please call (212) 639-5014.

Use this area to write in information when the clerk calls:

Date______________________________Time____________

On the day of your procedure, go to the MSK Presurgical Center (PSC).

MSK Presurgical Center (PSC)
1275 York Avenue
Between East 67th and East 68th Streets
New York, NY 10065
B elevator to 6th Floor
 

Sleep

Go to bed early and get a full night's sleep.

Do not eat or drink anything after midnight the night before your procedure. This includes water, hard candy, and gum.

Morning of your procedure

Medications

Your doctor or nurse practitioner may have instructed you to take certain medications the morning of your procedure. If so, list them below. Take only these medications with a small sip of water the morning of your procedure.

Do not eat or drink anything the morning of procedure. This includes water, hard candy, and gum. Take any medication as instructed with a small sip of water.

Things to remember

  • Do not apply any lotion, cream, powder, deodorant, make-up, powder, or perfume.
  • Do not wear any metal objects. Remove all jewelry, including any body piercings. The equipment used during your procedure can cause burns if they touch metal.
  • Leave valuables such as credit cards, jewelry, or your checkbook at home.
  • Before you are taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles such as a rosary.

What to bring

  • A pair of loose-fitting pants (sweat pants are a good choice).
  • Brief-style underwear that is 1 to 2 sizes larger than you normally wear.
  • Sneakers that lace up. You may have some swelling in your feet, and lace-up sneakers can accommodate this swelling.
  • CD player and CDs or iPod, if you choose. However, someone will need to hold these items for you when you go into procedure.
  • If you wear contacts, wear your glasses instead. Remember to bring a case for them.
  • Your Health Care Proxy form, if you have completed one.
  • This guide.

When you arrive

Parking

Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a tunnel that goes from the garage into the hospital. There are also commercial garages nearby: 4 on East 69th Street between First and Second Avenues and 3 on East 65th Street between First and Second Avenues. For questions about prices, call (212) 639-2338.

Tell us who you are

You will be asked to state and spell your name and birth date many times. This is for your safety. Patients with the same or similar names may be having procedure on the same day.

Tell your nurse about medications you've taken

A nurse will meet with you before your procedure. Tell him or her the dose of any medications you took after midnight and the time you took them.

Get dressed for your procedure

You will be given a hospital gown, robe, and nonskid socks. Do not bring anything extra with you. Storage space is very limited.

Prepare for your procedure

You will walk into the operating room or you can be taken on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help the circulation in your legs.

Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your procedure.

Once you are fully asleep, a breathing tube will be placed through your mouth into your windpipe to help you breathe

Once your procedure your breathing tube is usually taken out while you are still in the operating room.

Family and friends

You will get a fact card called Information for Family and Friends for the Day of Surgery to review. This information will tell your family and friends what to expect before, during, and after your surgery.

After Your Procedure

When you wake up after your procedure, you will be in the Post-Anesthesia Care Unit (PACU).

You will have an oxygen mask covering your nose and mouth. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You will have a Foley® catheter in your bladder to monitor the amount of urine you are making. You will also have compression boots on your lower legs to help your circulation.

Once you are fully awake, your oxygen mask will be taken off. You will receive oxygen through a thin tube that rests below your nose called a nasal cannula. Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. Depending on the procedure you had, you may stay in the PACU overnight.

Before and during your HDR treatment, you will be given a low-residue diet and medicine to prevent you from having a bowel movement. Some patients prefer not to eat food that makes them bloated or produces gas, as this makes them uncomfortable.

While the catheters are in place you must stay in bed. You will be lying on your back with your legs straight. You cannot move your hips or legs, but you can wiggle your toes. You can move your arms and upper body. Once your catheters are removed you will be allowed to get out of you bed with assistance.

While you are in your hospital there is nothing radioactive in your catheters. You may have visitors and do not have to be alone.

You will have some pain after your procedure. Your doctor and nurse will ask you about your pain often. You will be given medication to treat your pain as needed. You will be able to give yourself pain medicine by using a patient-controlled analgesia (PCA) device. You will get a fact card called Intravenous Patient-Controlled Analgesia (IV PCA) to review. If your pain is not relieved, please tell your doctor or nurse.

HDR Treatment

You will receive 2 or more HDR brachytherapy treatments while you are in the hospital. Treatments are done in the Department of Radiation Oncology treatment rooms. The radiation therapists will attach the catheters coming out of your perineum to cables which look like long, plastic straws. The cables are connected to a machine that stores the radioactive source Iridium.

Once everything is set, you will be left alone in the room to receive the HDR treatment. The room has a video camera and an intercom so staff can see and hear you at all times. The Iridium will be moved through the cables into your catheters. The Iridium is left in your prostate for 2 to 5 minutes. You will not see or feel the radiation Iridium while it is in your prostate. You may hear the machine humming but you will not feel any pain or discomfort. After the treatment is done, the Iridium is moved back into the storage machine. The radiation therapist will come back and disconnect the cables. You will then be taken back to your room.

After your last treatment, the template, catheters and Foley® catheter will be removed from your perineum.

Commonly Asked Questions

The following section covers common questions patients ask once they are discharged. Speak with your doctor or nurse if you have any additional questions or if any of this information is unclear.

Will I be given any medication?

You will be given a prescription for antibiotics. Take all the medicine that is prescribed. You will also be given a prescription to help with frequency and urgency of urination.

One to two weeks after your procedure you may feel burning when you urinate. You will be given a prescription for medicine to help with the burning.

Do not take aspirin, products that have aspirin in them, and vitamin E for at least 1 week after your procedure. You may take ibuprofen (Advil® or Motrin®).

Will I have pain?

Some pain is expected in the perineum for about 24 to 48 hours. You may take a mild pain reliever such as ibuprofen (Advil®).

What should I do if I have bleeding in my perineum?

If you have any bleeding in the perineum, apply steady pressure with a clean, dry washcloth or gauze for 5 minutes. If the bleeding becomes heavy or does not stop, call your doctor.

Will I have any bruising or swelling after the HDR brachytherapy?

Your testicles may have some bruising and swelling. This is normal and should go away on its own in about 3 weeks.

What are other side effects of the HDR brachytherapy?

  • Your semen may contain a small amount of blood for several weeks.
  • You may have temporary or permanent numbness in the head of your penis.
  • You may have a frequent urination for up to 6 weeks after your procedure.
  • Your urine may be pink tinted or have small amounts of blood in it for a few days after your procedure. Call your doctor if heavy bleeding occurs or if you pass blood clots.

Do I need a special diet?

No. After your procedure your may resume your regular diet.

When can I shower?

You may shower 24 hours after your discharge.

When can I lift heavy objects?

You should not lift anything over 20 pounds for at least 48 hours after your procedure.

Call Your Doctor or Nurse if You Have

  • New or worsening shortness of breath
  • A temperature of 101° F (38.3° C) or higher
  • Pain that does not get better with your medications
  • Any new symptom or physical change
  • Any questions or concerns

Resources

The following are MSK resources that you might find helpful.

Admitting
(212) 639-5014
Call the Admitting office to discuss private room or luxury suite options. If you want to change your room choice after your Presurgical Testing visit, call (212) 639-7873 or 7874.
 
Anesthesia
(212) 639-6840
Call with questions about anesthesia, the medication used to make you sleep during your procedure.
 
Blood Donor Room
(212) 639-7643
If you are interested in donating blood or platelets, call for more information.
 
Bobst International Center
1 (888) 675-7722
MSK welcomes patients from around the world. If you are an international patient, call the International Center for help coordinating your care.
 
Chaplaincy Service
(212) 639-5982
Spiritual and religious resources provide comfort and strength for many patients. The chaplains at MSK are available to help you access those resources and provide spiritual support for anyone. If you have a specific religious need, please call the number above. The interfaith chapel is located near the main lobby of 1275 York Ave. It is open 24 hours a day. If there is an emergency, please call the hospital operator and ask for the chaplain on call.
 
Counseling Services
(646) 888-0100
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.
 
Integrative Medicine Service
1 (800) 525-2225
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapies, yoga, and touch therapy.
 
Patient Financial Services
(212) 639-8242
Call Patient Financial Services with any questions regarding preauthorization with your insurance company. This is also called preapproval. Patient Financial Services can also help you with your billing or other insurance questions.
(646) 497-9176
Call the number above for general information about your insurance coverage. Remember, you must call your insurance company for preauthorization.
 
Patient Representative Office
(212) 639-7202
Call the Patient Representatives Office if you have any questions about the health care proxy form or if you have any concerns about your care.
 
Perioperative Clinical Nurse Specialist
(212) 639-5935
If you have any questions about MSK releasing any information while you are having procedure, call the clinical nurse specialist.
 
Private Duty Nursing Office
(212) 639-6892
Patients may request private nurses or companions. For more information, call the Private Duty Nursing Office.
 
Resources For Life After Cancer (RLAC) Program
(646) 888-4740
At MSK, care doesn't end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
 
Social Work
(212) 639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide counseling on getting used to having a serious illness, advice on how to communicate with family, friends, and young children, and help with employment issues.
 
Tobacco Treatment Program
(212) 610-0507
If you want to quit smoking MSK has specialists who can help. Call for more information.
 

Important Telephone Numbers

The following are resources outside of MSK that you might find helpful:

American Cancer Society
www.cancer.org
 
National Cancer Institute
www.cancer.gov
 

For additional web-based information, visit LIBGUIDES on MSK's library website at http://library.MSK.org. You can also contact the library reference staff at (212) 639-7439 for assistance.