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Urology Nurse Specialist
Kent & Sussex Hospital
NHS Direct
Maidstone Hospital
Pembury Hospital
References
1. Crook J, McLean M, Catton C, et al.
Factors influencing risk of acute urinary retention after TRUS guided permanent prostate seed implantation. Int J Radiat Oncol biol/Phys 2002; 52:453-460 2. Gelblum DY, Potters L, Ashley R et al.
Urinary morbidity following ultrasound-guided transperineal prostate Prostate Brachytherapy
Information for patients
IntJRadiat OncolBiolPhys 1999; 45:59-67 Developed by: Prostate Brachytherapy Team, Cookridge Hospital
Introduction
Adapted by: Prostate Brachytherapy Team, Kent Oncology Centre
This booklet has been written to tell you about Prostate Brachytherapy. Prostate Brachytherapy is a radiation therapy that can be used as a prostate cancer treatment and is capable of MTW NHS Trust is committed to making its patient information
delivering high and concentrated doses of radiation to the accessible in a range of languages and formats. If you need this leaflet in
another language or format please ask one of your clinical care team. We
prostate gland with relatively little radiation reaching the adjacent will do our best to arrange this for you.
organs. This booklet is only a guide and does not contain every possible Patient Advice and Liaison Service (PALS)
detail about the treatment. Please ask the staff if you have any If you would like to comment on Trust services, have concerns or need information, you can contact the Patient Advice and Liaison Service (PALS). PALS will listen to your views and using a wide range of contacts and resources, help find ways of resolving any queries or difficulties. The PALS What does Prostate Brachytherapy involve?
Team can be contacted at Maidstone or Kent and Sussex Hospitals, Monday Prostate Brachytherapy is performed as a two step procedure involving a prostate volume study followed by a radioactive
seed implant some two to six weeks later.
Hospital switchboard
0845 155 1000
Non-Surgical Oncology Services
Procedure One: The volume study
Cancer Research Campaign
Using a transrectal ultrasound probe inserted into the rectum, several images will be taken of your prostate gland. You will be awake during the procedure but sedation can be administered if required, and this may leave you feeling drowsy. Supporter Services
These images provide a three dimensional model of the prostate Switchboard
gland, which is used to determine the number and exact placement of iodine seeds needed to treat the prostate. You will be given an enema on the morning of the volume study National Cancer Alliance
to wash out your bowel. This is essential to produce a clear image of the gland. An enema involves passing a small amount of liquid into the rectum via a tube through the anus. Sometimes the gland is too large to implant (more than 50 cubic Telephone
centimetres) and you may need to have hormone therapy for three to six months to reduce the size of the gland. A repeat prostate volume study is performed after about three months to check if the gland has shrunk enough to allow it to be implanted. Contact numbers
Procedure Two: Radioactive seed implants (Brachytherapy)
Monday – Friday, 9am - 5pm
The procedure involves implanting radioactive lodine-125 seeds Prostate Brachytherapy Team
directly into the prostate gland where they continuously give off low level radiation for approximately one year. Each seed is 5mm Brachytherapy Physics
together in a strand for implanting. Using a Brachytherapy radiotherapists
the gland with a high degree of accuracy. National helpline numbers
Since only a small area is affected by the radiation of each seed, relatively little radiation reaches the adjacent organs. Prostate Cancer Charity
3 Angel Walk, London W6 9HX
What happens on the day of the prostate implant
Helpline
You will be admitted to hospital on the day of the implant. You will be given an enema on the morning of the procedure (information about the enema can be found under the section Administration
The implant is performed in the operating theatre under general anaesthetic, usually taking about 40 minutes to an hour. The seeds are loaded into special needles and inserted into the Prostate Support Association (PSA)
prostate gland through the skin between the scrotum and the Helpline
Most patients go home on the same day, once they have recovered from the anaesthetic and can pass urine freely. If you CancerBACUP
are unable to pass urine you will have a catheter put in place; it will stay in over night and be removed the next day. Freeline
Standard Rate Info Line
Diagram showing the
position of the needle
Administration
template
Macmillan CancerLine
After the implant
While in the recovery room you will have an ice bag placed between your legs to help reduce swelling over the implant area. You will be given Tamsulosin MR (Flomax®) on the evening of Freephone
the implant. This is an alpha-blocker tablet which relaxes the smooth muscle of the urethra (the tube that leads from the Text phone service available for deaf
bladder through the prostate and penis) and helps urination. and hard of hearing people
It is recommended that you continue to take Tamsulosin as prescribed until your urinary symptoms subside; this usually takes You will be given a ten day course of antibiotics (Ciprofloxacin) after the implant to prevent infection. Please take them as prescribed. There is no need to repeat the course unless advised this be appropriate. It might be useful to keep this leaflet with to by your doctor. Please read the information leaflet enclosed you, as well as the card if you are traveling abroad. The card can The anaesthetic may impair your concentration so for a minimum Follow-up schedule
of 24 hours after your operation you should not: After a seed implant you will see your brachytherapy team on a • drive a motor vehicle or ride a bicycle, so please arrange for regular basis. The follow-up schedule starts four weeks after the implant and usually includes a visit to the team every three to six months for the first five years, to check treatment progress. You may have a physical examination and blood tests during these visits. About four weeks after the implant you will have a • make any important decisions or sign any legal documents CT (Computed Tomography) scan. This is a special x-ray scan You may resume eating and have visitors as soon as you wish. which produces an image of a cross-section, or slice, of the body. You should avoid heavy lifting or strenuous physical activity for These scans allow us to ensure that the quality of our implants the first two days that you are at home. After two days you will remain at a high standard. The scan does not involve a drink or probably be ready to return to your normal activity level. injection. The scan does not monitor the effectiveness of the Side-effects of the implant
treatment and so you will not receive any results. You may experience some of the following immediately after the PSA stands for Prostate Specific Antigen. PSA is a protein made • mild soreness, bruising and discolouration in the area between by the prostate which naturally leaks into the bloodstream. The effectiveness of your treatment will be assessed primarily from your PSA blood test which will be checked regularly. The • some burning sensations when passing urine PSA will fall slowly over one to two years and may rise temporarily at times before going down again (PSA Bounce). The • incontinence (in less than two percent of patients who have not • temporary increased frequency / urgency of need to urinate PSA bounce or spike
• urinary retention (in approximately ten percent of patients) A PSA bounce or spike is a benign (non-cancerous) rise in the PSA. This usually occurs in the second year after the implant, Urinary problems
although it can occur earlier or later. About a third of men You may see a slight trace of blood in your urine for several hours receiving Prostate Brachytherapy experience this. There is no after the implant. This is quite normal, so don’t be alarmed. way at the moment to distinguish between a benign PSA rise and Drinking plenty of water, about one glass hourly during the day, a PSA rise caused when prostate cancer is active. If the PSA helps to flush out the bladder and reduce any blood clots. continues to rise for over 12 months or rises three or more times The radiation reaction from the seeds begins approximately one after treatment, this is likely to be due to recurrence of the cancer. week after the implant. This usually causes increased frequency • For the first two months of your implant do not sit close to and urgency of urination, which can sometimes be painful. The children (under the age of puberty). However, you may give them a cuddle or hold them for a few minutes each day. This For some patients these symptoms may be severe, but they can also applies to anyone you know who may be pregnant. There be eased with medication. These side-effects last for an average are no restrictions on physical contact with other adults. of four to six weeks and then gradually reduce in severity. Some • If you are experiencing stinging and burning sensations while urinary symptoms may persist for six to twelve months. passing urine in the first one to two weeks after the implant we Urine flow
After the implant, the urethra (the tube that leads from the • Use a condom for the first two to three ejaculations after the bladder, through the prostate and penis) can become inflamed, implant. There is a small risk of passing a radioactive seed. causing some restriction of urinary flow. Drinking plenty of fluids • Used condoms should be disposed of by double wrapping and (about two to two and a half litres per day of water or squash) placing in the dustbin.
helps to relieve some of the symptoms you may experience after • The radioactive seeds impose no restrictions on travel. the implant. It can also reduce the risk of urine infection. Tea, coffee and many cola drinks contain caffeine, which irritates Your information card
the bladder and can affect your urine output. It is advisable to After your implant you will be given two copies of an information restrict your intake of these until your urine irritations settle. card, one to carry with you and one to keep at home. It carries information about your implant and some contact telephone If you are passing urine frequently during the night try reducing numbers. Please carry it with you for three years. your fluid intake a few hours before going bed, and have sips of You must tell your next of kin about the card so they can act on it water if required during the night. A covered hot water bottle can in the event of unforeseen illness or death. Should you require help reduce the discomfort when placed over the bladder area. any future treatment or hospital care it is very important your GP If you have to wait before your urine starts to flow, having a warm bath or placing your penis into a bowl of warm water can help. In the event of your death within three years of the implant a Many men gain further improvement in their urine flow by normal cremation is not allowed because of the radiation hazard. increasing their Tamsulosin (Flomax) to two tablets per day, one There are also hazards for hospital staff carrying out post- in the morning and one in the evening. This is an unlicensed mortems. It is essential that hospital staff and funeral directors dose so please discuss this with your specialist team or GP first. are informed; the card will provide them with advice on who they A leaflet on the ‘Use of Unlicensed Medicines and Medicines Outside of their Licence’ is available. The card will also be useful to you when travelling away from You will only be given one month’s supply but you may need home. Many airports, seaports and some underground systems Tamsulosin (Flomax®) for three months or more until symptoms now have radiation detectors installed following recent terrorist subside. A repeat prescription should be obtained from your GP. incidents. They are very sensitive and may respond to your implant even though the radiation levels are very low. You can use your card to explain why this has happened. Please feel free to invite an official to telephone the Kent Oncology Centre should Incontinence
the rectum. This usually resolves by itself but if the rectum Incontinence occurs in less than two percent of patients who have becomes inflamed, and you experience a burning sensation after opening your bowels, an anti-inflammatory suppository may be required; please contact your GP. Retention of urine
Impotence
A small percentage of patients (up to ten percent) may develop acute urinary retention (unable to pass urine) and require a Impotence (inability to achieve satisfactory erections) may catheter (2). A catheter is a plastic tube inserted through the penis develop in the years following Prostate Brachytherapy, occurring into the bladder that drains the urine away. in 20-30% of patients. If this occurs it usually responds well to treatments that you can discuss with your GP, e.g. Sildenafil® If you feel considerable discomfort in the lower abdomen and are (Viagra) or Tadalafil® (Cialis), Valvenafil (Levitra®). Your only passing a few dribbles of urine or unable to pass urine at all, specialist doctor will discuss these risks with you.
you may have urinary retention. You should attend your local emergency care centre, as a catheter may need to be inserted. A Intercourse
letter will have been given to you, on discharge after your Please read the advice given below in the Radiation Safety
prostate brachytherapy, for you to hand into the emergency care centre should this occur. If a catheter is necessary it usually needs to remain in place for a few days before it is removed. Prostate Brachytherapy will almost definitely leave you infertile, Very occasionally it is necessary for the catheter to remain in but do not rely on this as your method of contraception. place for a few weeks or longer to allow the situation to resolve. Your semen may be discoloured as a result of bleeding that may have occurred during the implant. Sometimes ejaculation may be Please inform your consultant’s secretary or the specialist nurse if painful but this tends to settle over time. This treatment is likely urinary retention occurs so the appropriate support can be to permanently cause your ejaculate to decrease in volume and If a painkiller is required, an anti-inflammatory medicine such as Important
ibuprofen or Diclofenac is recommended. We advise you check A small area of the rectum overlying the prostate receives a high with your doctor or pharmacist if these medicines are suitable for dose of radiation. We strongly advise that you do not undergo an you and do not interact with other medicines you are taking. anterior rectal biopsy or a trans-rectal prostate biopsy in the
Contact your GP if a stronger painkiller is required. future as there is a risk that the area would not heal properly. So, Bowel problems
if you are to undergo an investigation of your bowel in the future, please contact us or ask your consultant to contact us. Sometimes you may feel as though you are constipated. This may be a result of swelling of the prostate caused by the implant. Radiation information
A high fibre diet and extra fluids are encouraged. Sometimes a Radiation Safety
bowel softener may be required (Lactulose or Movicol). These Your implant poses no significant risk to your family and friends. Although the seeds are radioactive, you are not. However, we
You may notice an increased desire to open your bowels. This will gradually settle. You may pass a small amount of blood from

Source: http://www.kentoncologycentre.co.uk/images/content/Prostate%20Brachytherapy.pdf