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
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.Back to top
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.
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.
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 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.Back to top
Preparing for 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.
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.
Several additional parking garages are also located nearby:
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.
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.
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 the bowel preparation kit your doctor instructed you to use if you haven’t already done so.
- 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.
This is also a good time to stock up on clear liquids to drink the day before your procedure.
Stop taking all herbal remedies. You will get a fact card called Herbal Remedies and Cancer Treatment to review.
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.
- You may have solid food for breakfast. Aim to finish your breakfast by 10:00 am.
- After breakfast, start the clear liquid diet. Drink 4 (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.
Clear liquid diet
|Food/Beverage||Drink||Do Not Drink|
Any products with any particles of dried food or seasoning
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.
Take your NuLytely® bowel preparation
Measure and throw out half of the solution (64 ounces). You will only drink 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.
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.
You can continue to drink clear liquids until midnight, but it is not required.
Note the time of your procedure
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:
On the day of your procedure, go to the MSK Presurgical Center (PSC).
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.
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.
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.Back to top
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.Back to top
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.Back to top
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.
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®).
Some pain is expected in the perineum for about 24 to 48 hours. You may take a mild pain reliever such as ibuprofen (Advil®).
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.
Your testicles may have some bruising and swelling. This is normal and should go away on its own in about 3 weeks.
- 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.
No. After your procedure your may resume your regular diet.
You may shower 24 hours after your discharge.
You should not lift anything over 20 pounds for at least 48 hours after your procedure.Back to top
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
The following are MSK resources that you might find helpful.
Important Telephone Numbers
The following are resources outside of MSK that you might find helpful:
If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.