The Procedure
The patient is admitted to hospital the day before the procedure for bowel preparation; (it is critical that the rectum and lower colon is clear such that the transrectal ultrasound probe has a clear view of the prostate throughout the procedure).
Patients should inform the doctor about all the regular medications he is taking, especially aspirin, anti-hypertensive, cardiac or anticoagulant (e.g. warfarin, heparin) or antiplatelet drugs such as Plavix. this. Patients should be off anticoagulant medications and off aspirin for two weeks before the implant. Similarly, diabetics should let the doctor know well in advance of this and any difficulties in diabetic control recently experienced.
The procedure is performed under general or spinal anaesthesia. The needles that will deposit the seeds are inserted through the perineal skin and dropped in the pre-planned location.
A composite figure ( demonstrates an implant of seeds on a frontal view pelvic x-ray (left panel), beside which is shown the distribution on CT scan in the transverse plane (middle panel). Then in the third column/panel on the right side is the template planning record, which the doctor uses to ensure the distribution of seeds is correct.
When the patient returns from the implant, a urinary catheter is in place and the perineum may be sore and somewhat bruised. The catheter is left in place and usually removed at midnight or the next morning after which the patient remains in the hospital until he has had two/three satisfactory urinary voidings, to demonstrate that the urinary pathway is functioning well before he is discharged.
The patient is discharged on a week's prescription of antibiotic and 'Flowmax' for a period of three to four months. Flowmax is an Alpha Blocker medication which helps to relax the muscles within the swollen prostate gland. This helps to reduce the narrowing of the urethra (the tube which carries the urine from the bladder to the penis) as it passes through the prostate gland so reducing urinary symptoms. The patient sees the doctor the following week. Any problems before then are reported to the ward staff or the Brachytheapy Co-ordinator at the Princess Grace Hospital.
After leaving the hospital, patients may resume most normal activities with a normal diet and plenty of fluids. Sexual activity may be resumed after a couple of weeks but condoms are advised for two months after the procedure in case of seed release ( see Precautions). Radiation safety is a concern; however, iodine-125 seeds are low energy radioactive sources and most of the dose never reaches the outside world and the strength of the radioactive seeds reduces with time. Nevertheless, see section on sensible precautions with regard to pregnant women and children. The risk to other people is very low and far below the legal level at which the person needs to be in a designated facility but once again see precautions for pregnant women and children.
