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Radioactive Implants for the Treatment of Prostate Cancer

This information describes the use of radioactive implants for the treatment of prostate cancer.

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). When brachytherapy is used to treat prostate cancer, tiny radioactive seeds are placed inside the prostate glands.

This booklet describes brachytherapy and its possible side effects.

Facts About Radioactive Implants

  • One of two radioactive sources is used: iodine (I-125) or palladium (Pd-103). Your radiation oncologist will tell you which is best for you.
  • The radioactive source is covered with titanium. It is shaped like a seed about the size of a sesame seed.
  • Depending on how big your prostate is, 50-125 seeds will be used.
  • The seeds are never removed.
  • A radiation safety officer will give you a card that you should carry with you. It tells you when the radioactivity will be gone. If you must go to a hospital for any reason before the date on the card, tell the doctor that you have had seeds implanted.

Before Your Procedure

Pre-surgical Testing (PST)

You will meet with someone from the brachytherapy team about 1 week before the procedure. He or she will review the details of the seed implant with you. You will also have pre-surgical testing (PST). This involves a physical exam and some tests. They may include routine blood tests, a chest x-ray, and an electrocardiogram (ECG).

Medications

Some medications and herbal products can cause bleeding. You will be given a guide called Common Medicines Containing Aspirin and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) that contains important information about stopping medications before your procedure.

Tell us if you take a blood thinner. Examples are warfarin (Coumadin®) or heparin. Call the doctor who prescribed the blood thinner and ask when you should stop taking it.

If you have diabetes, call the doctor who prescribes your diabetic medication. Ask if you should adjust the dose of your diabetes medication the evening before or the morning of the procedure.

Care partner

A responsible adult must go home with you after the procedure. We call this person your care partner. Arrange for this in advance. When you come in for the procedure, staff will ask for your care partner's name and phone number. If we cannot confirm your care partner, your procedure will be canceled. You may not take a taxi or car service without your care partner after the procedure.

Bowel preparation

Your bowel must be empty of stool. Follow the directions below.

2 Days Before Your Procedure

  • You will need to purchase the following supplies before your simulation:
    • One 5 mg tablet of bisacodyl (Dulcolax®). These are usually sold as a box of 10 tablets.
    • One gallon (128 ounces) bottle of NuLYTELY® with flavor packs (cherry, lemon-lime, orange, and pineapple). You will get a prescription from your healthcare provider.
  • If you have any of the following talk to your doctor as you may need to take additional precautions:
    • Kidney failure
    • Congestive heart failure
    • Diabetes

1 Day Before Your Procedure

  • You may have solid food for breakfast. Aim to finish your breakfast by 10:00 am.
  • After breakfast, start the clear liquid diet. Drink four, 8 ounce glasses of clear liquids for lunch. You may NOT have milk or any milk products.
  • Limit caffeinated beverages to 2 cups. Do not drink alcohol.
  • Do not drink diet liquids, even if you are a diabetic. This may result in feeling weak or dizzy.

Prepare your NuLYTELY® bowel preparation solution

On the morning of the day before your procedure, add lukewarm drinking water to the NuLYTELY®, filling it to the top of the line on the bottle. Add a flavor pack, if you choose. Use only a flavor pack that was provided with your NuLYTELY®. With the cap on, shake the bottle until the powder is dissolved. The mixture will be clear, even if you used a flavor pack. Place the bottle in the refrigerator to chill it as patients have told us it tastes better cold. Do not mix the NuLYTELY® earlier than the morning before your procedure.

Drink only half of the NuLYTELY® solution (64 ounces). Throw out the other half.

At 1:00 pm on the day before your procedure, take 1 bisacodyl tablet by mouth with a glass of water.

At 3:00 pm on the day before your procedure start drinking the NuLYTELY®.  Drink an 8 ounce glass of the mixture every 15 minutes, until you finish 64 ounces of the solution. Then, continue drinking clear liquids.

The NuLYTELY® will cause frequent bowel movements, so be sure to be near a bathroom when you start drinking it. To help prevent irritation, you can apply petroleum jelly (Vaseline®) or A&D® ointment to the skin around to your anus after every bowel movement.  

After midnight

  • Do not eat or drink anything after midnight. This includes water, ice cubes, hard candy, and chewing gum.
  • You may take any medications that your nurse or doctor have told you to take. Take them with a small sip of water.
  • Shower using soap and water the night before or the morning of the procedure.

Clear Liquid Diet

Food Group Recommended Excluded

Soups

  • Clear broth or bouillon
  • Clear consommé
  • Packaged vegetable, chicken, or beef broth-mix without any particles of dried herbs or seasonings

All others

Sweets and Desserts

  • Gelatin
  • Flavored ices
  • Sugar
  • Honey
  • Sugar substitutes

All others

Beverages

  • Clear fruit juices such as apple, cranberry, grape, orange
  • Soda such as ginger ale, 7-Up®, Sprite®, seltzer, cola
  • Gatorade®
  • Black coffee
  • Tea

All others including

  • Nectars
  • Milk
  • Juices with pulp
  • Alcoholic beverages

The Day of Your Procedure

  • Do not have anything to eat or drink.
  • Do not swallow any water when rinsing your mouth after you brush your teeth.
  • Your doctor or nurse practitioner may have instructed you to take certain medications on the morning of your procedure. Take only those medications with a sip of water.
  • Pack your other medications and take them with you. You will be able to take them after the procedure is completed.
  • Do not wear contact lenses or any jewelry.
  • Shower using soap and water the night before or the morning of the procedure.
  • Do not apply any lotions, creams, deodorant, or powders.
  • Leave your valuables at home.
  • You will be shown into a dressing room and asked to change into a hospital gown.
  • A nurse will briefly interview you. He or she will take your vital signs, start an intravenous (IV) line, and explain the procedure that will be done.

Insertion of the seeds

The implant procedure is done under anesthesia. You will be in the operating room in the Surgical Day Hospital for about 2 hours. After you are asleep, a urinary catheter will be inserted through your penis into your bladder. It helps the doctor see the prostate. It also keeps the bladder empty so that it will not fill with urine. Urine in the bladder could change the shape of the prostate during the procedure. Thin, stainless steel needles will be placed throughout the prostate gland. They are inserted through the perineum. This is the space between the base of the scrotum and the anus. An ultrasound probe will be inserted into the rectum to create an image of the prostate gland. A computer determines the best placement of the seeds within the gland. A type of x-ray exam will also be used to help see the prostate gland. It guides the placement of the seeds through the needles. The needles will be removed after the seeds are placed.

After Your Procedure

You will be taken to a recovery area, where nurses will monitor you. You will be there for about 2 hours or until the anesthesia wears off. During this time, a physicist from the Radiation Safety Service will visit you. He or she will check the level of radiation in your body. The physicist will teach you about what you can do at home to protect people from the small amount of radiation given off by the seeds.

Once you are awake, you will be taken to have x-rays and a computed tomography (CT) scan. These are done to confirm the location of the seeds. Once this is done, the urinary catheter will be removed. After you have urinated you can go home. Remember, you may leave only with your care partner. You may not drive yourself home.

Discharge Instructions

  • Some patients are unable to urinate after the implant procedure. This is rare, but it can happen because of swelling. If this happens, call your radiation oncology doctor. You may need to have a urinary catheter put in place.
  • You may have some pain for a day or two. If acetaminophen (Tylenol®) does not relieve it, call your doctor or nurse.
  • Do not take aspirin, vitamin E, or products containing them for at least 1 week.
  • You may see black and blue marks around your scrotum and penis. These will disappear within a week.
  • You may notice blood in your urine. This is common and usually disappears after 3 days.
  • You may return to work 48 hours after the procedure.
  • Do not lift heavy objects or do strenuous activities for the first 2 days.
  • Very rarely a seed may be passed with your urine. Losing a seed will not affect your treatment. Check for this by straining your urine for 4 days after the procedure. We will give you a special strainer to use for this. If you pass a seed, pick it up with a spoon or a pair of tweezers. Place it in a small covered container, such as an empty jar. Store it away from people. The spoon is safe to use again once it is washed. Do not touch the seeds with your fingers or hands. Call your radiation oncologist or the Radiation Safety Service at (212) 639-7391 for further instructions. If you do lose a seed during the first 4 days, keep straining your urine for another 4 days.

Radiation safety precautions

The seeds give off a very small amount of radiation from your body. It decreases the further it gets from your body. There is no measurable radiation 3 feet away. You cannot harm anyone by briefly hugging, kissing, or shaking hands. You can be in the same room with anyone, including pregnant women.

You will be given specific instructions by a physicist from our Radiation Safety Department about radiation safety precautions around family and friends. He or she will also give you a wallet card to keep with you for 6 months after your procedure.

The radiation from the seeds will not get into your blood, urine, or other body fluids. You cannot make something radioactive by touching it. You do not have to do anything special with linens, clothing, dishes, or in the bathroom. The seeds will not disturb pacemakers or microwave ovens.

You may resume sexual activity 1 week after the implant. The prostate gland secretes some of the fluid that makes up the ejaculate. A seed may be passed from the gland during ejaculation. This is rare. Use a condom or ejaculate outside of your partner for at least the first 5 ejaculations. This may lessen any worry about being able to ejaculate after the procedure. It also lets you check to see if a seed is in the ejaculate. Call your radiation oncologist or radiation safety if this occurs.

If your partner is pregnant, use a condom until the baby is born. This will prevent a seed that may be passed in the ejaculate from being lodged near the growing fetus.

It is safe to travel but, be aware of one precaution. Some security monitors can detect radiation. It is possible that you could be stopped at some point within the first 6 months after your seeds are implanted. We will give you a wallet card to carry. It explains that you have had an implant. It also provides a hospital number to call, if needed.

Side Effects of Treatment

The seeds are placed directly into the prostate gland. There is minimal radiation to nearby normal tissue. However, even that small amount could result in side effects.

Urinary

Urinary symptoms are the most common side effects. You may need to urinate as often as 1 or more times an hour. This usually begins 2 to 4 weeks after the seeds have been implanted and can last several months or longer. If needed, we will give you medication to decrease the number of times you need to urinate.

You could also have some burning during urination. It begins 2 to 4 weeks after the seeds have been implanted and can last for about 4 to 12 months. It is rare, but some men have a narrowing of the urethra. The urethra may need to be dilated.

Bowel

You can also have changes in bowel habits. They are from irritation to the rectum. They include increased frequency of bowel movements and soft stools. Symptoms may begin 1 week after seed implementation and can last several months or more. It is rare, but some men get ulcers in the rectum. They usually heal without problems. If you have hemorrhoids, they may get worse. You could have rectal discomfort or mucous discharge.

If you get urinary or bowel symptoms, discuss them with your radiation oncologist. Do not have any procedure before you do so. This includes an endoscopy to look into the bladder or look into the rectum or colon.

Erectile dysfunction 

About 30% of men will develop erectile dysfunction (often referred to as impotence) within 5 years of the implementation procedure. It is difficult to predict who will be affected. You may also notice a change in the strength of your erection. You may have less ejaculate or the consistency may be different. If impotence does develop, it may be permanent. Please let us know if this happens. There are many treatments.

If you have any questions about these side effects, please speak to your doctor or nurse.

Follow-Up Care After Your Procedure

Your doctor will want to see you at regular intervals after your treatment. At each of these visits, the team will evaluate your response. You will have a physical exam and blood tests, including a PSA. The doctor and nurse will review any symptoms you may have. Use these visits to ask questions and discuss your concerns. After the first year, your doctor will decide the frequency of your visits.

Additional information

The best place to get more information is from your healthcare provider. There is a lot of information about radiation and cancer on the Internet and some of it is confusing and inaccurate. We recommend the American Cancer Society website, www.cancer.org.

You can also visit the Memorial Sloan Kettering Cancer Center Library online at http://library.mskcc.org. Do not hesitate to contact reference staff at (212) 639-7439 or by using the “Ask-a-Librarian” link (https://library.mskcc.org/help/ask-librarian).