The side effects of seed therapy can vary widely from one patient to the next. Most
patients experience tenderness in the perineum for several days following the implant.
Bruising and discoloration can extend into the scrotum. This should not alarm you.
The perineal discomfort is usually mild to moderate and can be managed with Tylenol,
Aleve, or Ibuprofen. These medications are okay to take after your implant.
2) Urinary Symptoms
In the first 24-48 hours, there may be moderate to severe burning on urination. The
urinary stream may be very weak. About 5% of the patients find it impossible to
urinate at night and must return to the hospital emergency room for placement of a
Foley catheter. If urinary blockage occurs during the day, please contact your
Urologist. He or she may be available to place a catheter in their office.
For several weeks or months, patients will experience urinary urgency, frequency and
irritation. These symptoms can be mild, moderate or severe and tend to be worse at
night. Initially, most men find that they get up at night to urinate 2-4 times more than
they did before the implant. Men who have burning on urination usually report that
this discomfort is felt on the tip of the penis. This is not the result of any injury to the
penis, but rather these sensations are being referred to the penis from the prostate.
Medications called alpha-blockers (Flomax, Hytrin or Cardura) are particularly
helpful in relieving these symptoms. These medications help the prostate to relax,
allowing the urine to pass more freely through the swollen and inflamed gland.
Anti-inflammatory medications such as Aleve or Ibuprofen can also be very helpful.
Occasionally, there is bladder irritation. In that case, patients may benefit from
Pyridium, which numbs the bladder.
Urinary urgency can be rather severe for a month or two after the implant, and if
the patient is not careful, an accident might occur. In order to avoid urinary
leakage it is best to set-up a schedule and void every hour while awake. Severe
urgency is often triggered by standing up or touching water. So be prepared to rush
to the bathroom in those situations. Be prepared to quickly find a bathroom when
you hop out of your car. If you have been sitting in a meeting at work for more than
an hour, be prepared to rush to the bathroom when you stand up. Never pass up
the opportunity to use the men's room.
How long do the urinary symptoms last?
The urinary symptoms can last for many months. They tend to last longer with I-125
seeds than with Pd-103 seeds. However, at some point, usually 6-8 weeks after the
implant, the symptoms will begin to improve. By 3 months, most men who have a Pd-
103 prostate seed implant, will say that their urinary function is 90% back to normal,
and that they are getting up at night one extra time or the same number of times as they
did before the implant. Urinary burning may last only a few days, however, as the
radiation dose builds up in the prostate, the burning sometimes returns between the 3rd
and 6th week after the procedure. If this is the case, the burning usually resolves by 3
months. The last symptom to go away is the weak stream. The strength of the stream is
usually pretty good by 3 months, but it may take another couple of months for the stream
to fully return to normal. Alpha-blockers are usually discontinued between the 3rd
and 4th month. Occasionally the urinary stream never fully recovers and patients may
stay on long-term alpha-blocker medication.
Urination at Night
The most common urinary complaint is frequent urination at night, which can
significantly interfere with sleep. Patients report that they will get up many times to
urinate, but that the stream is weak and that they cannot empty their bladder. This
will cause them to get up again soon thereafter. Sometimes patients are unable to get
their stream started for 5-10 minutes. Infrequently patients have severe burning and say
that urination feels like they are "peeing through razor blades." Alpha-blockers are
very helpful for nighttime symptoms, and unless you are instructed otherwise, it is
best to take these medications about 1 hour after dinner. It is also helpful to avoid
fluids in the evening to reduce the number of times that you get up at night.
The template coordinate grid seen above is activated so that it appears on the ultrasound
screen. The prostate is aligned so that it is superimposed onto the
template grid in such a way that the D row is centered in the central portion of the
prostate and the 1 row is aligned along the back edge of the prostate.
Example of how the template is used in a prostate implant: If the implant is to start at
the location of "F2" on the grid, the needle is placed through the "F2" aperture in the
template and, under the guidance of the ultrasound, is directed into the prostate at the
"F2" location as seen on the ultrasound screen. If the needle does not hit the "F2"
coordinate, it can be easily steered into the proper location. Depending upon the size of
the prostate, 16-26 needles are used to implant 60-140 seeds.
Once the procedure is completed, the patient is transferred to the recovery room. After
the anesthesia has worn off the patient is discharged to home. In most cases the Foley
catheter is removed prior to discharge.
3) Rectal Symptoms
Patients occasionally experience rectal urgency, frequency, discomfort or bleeding.
Bleeding is more likely to occur in patients with hemorrhoids. Ointments or
suppositories can help with these symptoms. These symptoms are usually mild.
4) Sexual Function
It is not necessary to abstain from sexual activity, however a condom should be used
for the first several sexual encounters or for the first several months to avoid
ejaculating a radioactive seed into another person.
Erectile dysfunction (ED), or difficulty with erection during sex, may occur
immediately after the implant. This is likely due to bruising of the nerve to erection.
This may recover spontaneously. In the meantime, ED can be treated very successfully
with Viagra, Cialis, or Levitra. Some patients report a mixture of pleasure and pain
during orgasm. Usually the discomfort resolves by 3-4 months. The semen is almost
always discolored (dark) for several months due to the presence of old blood. The
ejaculatory ducts may become blocked, and semen production by the prostate may be
impaired, resulting in a marked diminution in the volume of ejaculatory fluid at the time
5) Miscellaneous Symptoms
Patients will usually experience some fatigue. It usually resolves by 3-4 months. Your
blood counts are not affected by this treatment. There will be no hair loss.