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  Prostate Cancer: Radioactive Seed Implants

Side Effects

1) Perineal Symptoms

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 of orgasm.

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.

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