Prostate Cancer
Brachytherapy (Radioactive Seed Implantation)

Radioactive seed implantation, also known as brachytherapy, is one of the many treatments offered at the Center for Prostate Care at Baptist Cancer Institute. A growing number of men are choosing this procedure for treatment of prostate cancer because of its excellent long-term results and minimal side effects. Studies recently published in major medical journals have shown that with 13 years of follow-up, a seed implant is a very effective treatment for prostate cancer. Approximately four out of five men who received seed implants were cancer free 13 years after their seed implants¹.
¹Ragde et al, Arch Esp Urol 2001 Sep;54(7):739-747

Prostate seed implantation uses radioactive seeds that are each smaller than a grain of rice. The seeds are made of titanium and contain
a small amount of either radioactive palladium or iodine. After placement, the seeds will emit an intense amount of radiation to the cancer in the prostate and only minimal radiation outside the prostate to , other areas, such as the bladder and rectum. The seeds give off radiation for a few months and then are permanently inactive. Because cancer cells are much more sensitive to radiation than normal cells, they can be selectively killed.

A minor procedure performed in the hospital, prostate seed implantation takes less than one hour. Men typically report to the hospital in the morning and return home a few hours later. It is very common for men to return to their normal activities within 24 hours. Very thin needles are used to perform the entire procedure, and, thus, no cutting is involved, and no stitches are required. Patients receive either a light general or spinal anesthetic for the procedure, so there is no discomfort from the needles. An ultrasound is used to obtain a live picture of the prostate and provide for the most effective placement of the seeds. Following the successful placement of seeds in and around the prostate, all the needles will be removed, and patients are then taken to the recovery area. Once the anesthesia has worn off, patients typically go home and often return to their normal activities that next morning.

Most men experience only temporary side effects after the implant. Because there are no incisions required, there should be no pain after the procedure. In fact, most men do not even require any pain medicine. The most common complaint is temporary irritation of the urinary stream lasting only for a few months. It is common to experience varying degrees of increased urinary urgency and frequency. Some men notice some slight stinging when they urinate. Medications can be given to help alleviate most of these symptoms.

Long-term side effects following a prostate seed implant are generally quite uncommon. Unlike surgery, more than 99 percent of men are continent and completely able to control their urine. In addition, more than two out of three men treated with an implant alone should preserve their sexual potency (their ability to have erections). The likelihood of radiation permanently damaging any surrounding tissue outside the prostate is very low, at less than 1 percent.

What Is the Real-Time Technique and Why Is It Important? To have optimal results from your prostate implant, it is vital that all areas of the prostate are covered with seeds, and that no sensitive areas outside the prostate are implanted. Using the Real-Time technique, there is minimal risk of placement of needles or seeds too close to the bladder, rectum, urethra, or nerves. Any motion of the prostate or change in its size or shape during the procedure can be immediately taken into account, ensuring good seed placement.

This Real-Time technique differs greatly from the older, Pre-Planned or "Seattle" technique. That technique involves mapping out the prostate a few weeks in advance by ultrasound. Then, when the man goes to the operating room, the prior ultrasound is used to determine where to place the needles and seeds. The Pre-Planned technique unfortunately does NOT take into account any differences in the size, shape, or position of the prostate at the actual time of surgery. It has been our experience that the prostate can be very different at the time of surgery. Subtle changes in leg position, the degree of bladder filling, the use of anesthesia, and the shape, of your prostate after the needles are inserted can have profound effects, making a pre-plan virtually useless.

In contrast, using powerful computers and experience based on thousands of previous cases, the Real-Time technique takes all of the above possible changes into effect. All of the needles and seeds are placed based on how the prostate looks at the time of the procedure, not how it looked weeks before. (Physicians with the Baptist Health's Center for Prostate Care are using this technique.)

Intra-operative Computer Planning

Physicians with the Center for Prostate Care have helped pioneer the use of powerful computers during the implant procedure to instantly calculate the dose of radiation received by the prostate and surrounding areas. The computer can obtain and analyze live images of the prostate gland throughout the implant procedure to further ensure optimal seed distribution and placement. This is a major improvement over older techniques where the amount of radiation received by the prostate could not be determined until after all the seeds were implanted. Currently, no other radiation oncology group in Florida is using this technique.

Your Prostate Seed Implant Team

Should you choose to undergo a prostate seed implant at the Center for Prostate Care, both your urologist and radiation oncologist will be involved in the planning and placement of the radioactive seeds. Support to the physicians will be provided by a dedicated and experienced group of nurses and radiation physicists. Receiving care from this team will allow you to benefit from their years of training and expertise.

The Center for Prostate Care has physicians dedicated to the treatment of prostate cancer, with research publications, lectures, and experience performing and teaching prostate seed implants around the United States and Europe. Their experience will allow you to feel confident that you have obtained the best possible care.