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PROSTATE SEED IMPLANT
(also known as Brachytherapy)
Most
men with prostate cancer are choosing a radioactive seed implant for treatment due to its superior long-term results and lack
of long-term side effects. Our own recently published studies have shown that with 10 years of follow-up, a seed implant is
a very effective treatment for prostate cancer. If found early, more than 95% of our patients are cured of their cancer. Prostate
seed implantation is based upon the use of tiny radioactive seeds, each smaller than a grain of rice. The seeds are made of
titanium and contain a small amount of either palladium or iodine. After placement, the seeds 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 are permanently inactive after a few months. Cancer cells are much more sensitive to radiation than normal cells
and can be selectively killed.
Implant Procedure A seed implant is a one-time out-patient procedure that takes less than an hour. Men typically
report to the hospital in the morning, and return home a few hours later the same day. Most men return to their normal activities
within 24 hours. The entire procedure is done through very thin needles; so there is no cutting involved and no stitches are
required. The procedure is done under either a light general or spinal anesthetic, so there will be no discomfort from the
needles. With an ultrasound in the rectum, a live picture of the prostate is obtained, and the needles can be precisely
placed by the Urologist through the perineum (the skin between the scrotum and rectum). The Radiation Oncologist then inserts
the seeds through the needles. Following the successful placement of seeds in the prostate, all the needles will be removed.
Once the anesthesia has worn off, you can go home. Many men return to their normal activities that next morning, and can return
to work, playing golf, etc.
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Possible Side Effects
Most men experience only temporary side effects after the implant. Because there are no incisions or stitches required,
there should only minimal discomfort after the procedure. 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.
Medications can be given to help alleviate these symptoms. Long term side effects after the seed implant are very uncommon.
Unlike surgery, 99% of men are continent and completely able to control their urination. In addition, up to 90% of men treated
with a seed implant can preserve their sexual potency (ability to have erections). By precisely placing the seeds in the prostate
with the Procision™ technique, the incidence of seed migration outside the prostate is less than 1%. The likelihood of radiation
causing any serious damage to any surrounding tissues outside the prostate is consequently minimal in our hands.
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What is the Procision™ Seed Implant Technique?
Why is it so important?
To have optimal results from your prostate seed implant, it is essential that all areas of the prostate are covered with
seeds, and that no sensitive areas outside the prostate are implanted. Using the Procision™ 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 perfect seed placement. Because
seeds are precisely placed in the prostate, the risk of seeds migrating outside the prostate is less than 0.4%.
The Procision™ Technique differs greatly from the much older “pre-planned or Seattle technique.” The pre-plan technique
involves mapping out the prostate a few weeks in advance by ultrasound. Then, when the patient goes to the operating room,
the prior ultrasound is used to determine where to place the needles and seeds. The pre-plan 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 Procision™ 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. The doses of radiation to the various areas are calculated live,
in Procision™.
Intra-operative computer planning
Our physicians 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 group in Florida is using this technique.
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