Prostate Brachytherapy is a form of radiation therapy that’s used to treat prostate cancer.
After you and your urologist have decided to proceed with brachy therapy, a volume study may be needed to accurately determine the size of your prostate; this allows us to customize your seed implant treatment and order the appropriate number of radioactive seeds. This information may be obtained from the prostate ultrasound done when your prostate biopsy was performed.
A PATIENTS GUIDE TO PROSTATE BRACHYTHEARPY
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Table of Contents
Prostate Volume Study 2 Prostate Seed Implant 2 Pre-Implant Instructions 3 Clear Liquid Diet 4 What to Expect 5 Discharge Instructions 6 Medications 7 Implant Side Effects 9 Radiation Safety Precautions 10 Post Implant Guidelines 10 Important Points To Remember 12
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Prostate Volume Study
After you and your urologist have decided to proceed with brachy- therapy, a volume study may be needed to accurately determine the size of your prostate; this allows us to customize your seed implant treatment and order the appropriate number of radioactive seeds. This information may be obtained from the prostate ultrasound done when your prostate biopsy was performed.
Prostate Seed Implant
After your volume study and/or original prostate ultrasound are reviewed, several things must be done to prepare for your implant. Although in special cases these things can be done in a few days, it is more likely that two to three weeks will elapse before everything is ready for your implant.
You will be asked to meet with a radiation oncologist, a radiation oncologist, a physician who specializes in the treatment of cancer using radiation. He will confer with you urologist and a medical physicist to develop a preliminary plan to deliver a specific radiation dose to your prostate.
The radioactive seed are then ordered. The vendor fills the seed order specifically for you case (the shipping documents we receive even have your last name on them). When the seeds are delivered, we first assay them to be sure they are the active level that was prescribed. Then they are sterilized, and brought into the operating room immediately before the procedure.
During the procedure, the prostate s re-imaged; this final precise picture is entered into a sophisticated planning computer and a specific finalized plan for you implant is developed in real-time, in the operating suite.
Seed Implant Prep
You will be instructed to follow bowel preparation procedures prior to your seed implant. It is very important to follow these instructions.
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You will receive a phone call one to two days before the day of the treatment. A nurse will review and clarify all instructions related to seed implantation. At this time, she will address any questions or concerns you may have.
Pre-Implant Instruction
TWO WEEKS BEFORE YOUR PROSTATE SEED IMPLANT:
- Do not take any aspirin, ibuprofen, Nuprin, Advil or Aleve for two weeks prior to your implant.
- THE DAY BEFORE YOUR PROSTATE SEED IMPLANT: Begin a clear liquid diet the day before your procedure. Continue to drink lots of liquid up until midnight.
- At about 4:00PM the day before your procedure drink a FLEETS PHOSPO SODA (11/2 oz). Follow this with 4 glasses of water. This is a laxative.
- Do not drink alcoholic beverages or smoke for 24 hours before or after you implant.
THE DAY OF YOUR PROSTATE SEED IMPLANT
Arrive at __________ am/pm.
Your implant is scheduled for______.
Do not have anything to eat or drink (no water, gum, coffee, mints, Juice, etc.) after midnight the night before your procedure.
Take prescription medications such as blood pressure pills, heart, asthma, and emphysema medications, after your wake up. Take these pills only with a tablespoon of water if necessary.
Do not take diuretics the morning of your implant.
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IF YOU ARE DIABETIC: Do not take insulin or oral diabetic pills the morning of your implant-bring the medication with you. We will administer your dose after testing you blood sugar.
The morning of your procedure give yourself a FLEET ENEMA one hour before you are scheduled to arrive. The enema can be purchased over the counter.
You must have a responsible person drive you home and be with you for 24 hours following the procedure. You should not drive or operate machinery for 24 hours following the implant. It is not advisable to sign documents or make important decisions during this 24 hours.
You should wear comfortable clothes. Do not bring large amounts of money or jewelry. You should wear glasses instead of contact lenses. You should shower or bathe the evening before or the morning of the implant.
Clear Liquid Diet
Follow this diet the day before your implant NO MILK OR MILK PRODUCT
FOOD GROUPS
Fruit Juices Deserts
Beverages
Soups Miscellaneous
FOODS ALLOWED
Apple, Cranberry, Cranapple
Jell-o, Fruit Flavored Ices, Popsicles
Water, Lemon- Lime Soda, Ginger Ale, 7- UP, Sprite, Tea, Coffee
Broth, Bouillon, Consommé
Condiments: Salt Sweets: Sugar and Hard Candy
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What To Expect
On the day of your implant, you will be at the hospital for approxi-mately four to five hours. It is important to arrive at the center one hour prior to your treatment time. Total time for the seed implant-tation is 2 to 3 hours.
Pre-Op Suite
You will be asked to change into a gown. At this time you will sign a consent form for the procedure. A nurse will review your current health status and medications with you. Vital signs, tem-perature, blood pressure, pulse, and respirations will be taken. In addition, and intravenous line (IV) will be started. Finally, the anesthesiologist will review your health history with you, explain the anesthetics to be used, and answer any questions. Your wife or other family member may accompany you at this point.
Treatment Room
The radiation oncologist and your urologist work together to perform the seed implant. The doctor directs the needle through the perineum into the prostate gland under ultrasound guidance. The needles are filled with radioactive seeds according to the plan that will be prepared by our medical physicist and dosimetrist, during your procedure.
Once the seeds are implanted a cystoscopy will be performed by the urologist. A cystoscopy is the passage of an instrument through the urethra and into the bladder. This allows the doctor to visualize bladder.
Recovery Room
When your implant is finished, the anesthesiologist will awaken you. You will then move yourself or be assisted to a cart and brought to the recovery room. There, you will be monitored and observed until you are fully awake and stable. An ice bag will be applied to the perineum where the seeds were placed, to minimize discomfort and swelling.
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Once you are awake, you will be given sips of water. When you are fully awake and stable, you will be ambulated to a chair. This is usually about one-half (1/2) hour after you arrive in the recovery room. As soon as you are up in the chair, you will be given liquids to drink and some cookies or crackers.
Your family or friends will then join you. At this time, post implant guidelines and discharge instructions will be explained to you and your family members or friends. Any questions you have will be answered at this time.
Discharge Instructions
Medications
Anitbiotics:_____________Take___tabs ______times a day. Take this medication as prescribed until it is gone. No refills are usually necessary.
Anti-Inflammatory: This medication is to help decrease inflamma-tion and swelling in the prostate to help relieve or prevent urinary symptoms. You many taper usage when symptoms subside. These medications may irritate the stomach and should be taken with black stools, stop the medication and notify your physician. ____________Take___tabs__times a Day for ____days.
Pain/Discomfort: Most patients experience mild discomfort or a burning sensation. Your physician may prescribe a pain reliever
in case your need one. For mile discomfort, Tylenol plan or extra strength 1-2 tablets or Aleve 2 tablets, three times a day may be used. (Aleve is used for inflammation and pain relieve) Other:
[] Hytrin______starter pack_____mg at bedtime
[] Flomax 0.4 mg daily approximately 1⁄2 hour following the same meal each day.
[] Cardura _____ mg daily.
These medications are used to help relax the muscles in the blad-der and around the urethra to improve urination. You may be on this medication for a few months or more.
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Follow Up Care
Urologist:
Dr. ______________ at _________call to make a follow-up appointment in ______ weeks.
Radiation Oncologist:
Dr. _________________ at ____________ for: _______ follow-up appointment in ____ weeks _______ any implant or radiation problems or questions
A PSA test should be done in three (3) months and at regular inter- vals thereafter.
The radiation department will perform a CT Scan of your pelvis; this will be scheduled during your visit with the radiation oncolo-gist.
Foley Catheter Follow-up:
Follow-up phone call- You will be called a day or two after your implant to see how you are doing and to answer any questions you may have.
Medications Antibiotics
Cipro, Bactrim,Other
These medications are given to prevent infection, and they should be taken until they are gone, usually for a week or more. Occa-sionally, an allergic reaction may occur. Call your urologist if you develop a rash or any unusual reaction.
Anti-Inflammatory Drugs
Aleve (Naproxen Sodium), Toradol, Medrol
Anti-inflammatory medication is often taken for arthritis or mild pain. These are over-the-counter drugs. The purpose of anit-inflammatory medications is to reduce the inflammation
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and swelling in the prostate to improve urinary flow. This medication may upset the stomach and therefore should always be taken with food. If you feel this medication is not helping, discontinue it.
You may want to continue taking it for several weeks or more to help with urinary symptoms. If you develop stomach or abdomi-nal pain or have black stools after use of this medication, stop it and inform you physician.
NOTE: for this and all pain relievers, if you generally consume three (3) or more alcoholic-containing drinks per day, you should notify your physician for advice on when and how you should take pain relievers.
Medications to Improve Urinary Flow
Hytrin, Doxasasin, Cardura, Tamsulosin, Uroxatrol, Flomax, Rapitlo
These medications help to relax the muscles in the bladder and around the urethra to help improve urinary flow. A possible side effect of this medication is the lowering of your blood pressure. Initially, these medications may cause a light- headedness or dizzi-ness. Should this occur, sit or lie down immediately until the sen-sation passes. Once your body adjusts to the medication, dizziness and lightheadedness no longer occur. Be aware that a lowering of blood pressure may be accentuated by hot weather, alcohol, and exercise. This medication may be taken for several months. Your physician will advise you on when to discontinue its use. Discon-tinue the medication and call your urologist if any serious side effects develop.
Mild Pain Relievers
Tylenol (Acetaminophen) 325mg
Tylenol Extra Strength 500mg
These are over-the-counter pain relievers. You may take 1-2 tab-lets every four hours as needed for pain. This medication may be taken with Aleve.
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NOTE: Aleve is for both mild pain and inflammation. Implant Side Effects
Needle Puncture Site
The perineum may be tender, swollen, bruised, and may bleed slightly. You may notice swelling and bruising in the penis and scrotum as well. This is quite normal and is not a concern. Patients do not usually experience severe pain from this procedure. Mild discomfort or a burning sensation is common. The application of an ice bag for twenty (20) minutes, every two (20 hours, and a mild pain reliever should relieve any discomfort.
Urinary Symptoms
After a prostate implant, it is common to experience some difficulty with urination. You may experience some burning when you pass urine and notice some blood in the urine. Any bleeding usually resolves within forty-eight (48) hours. If it should persist beyond that, then notify your urologist.
Other common urinary symptoms are: frequency (a need to urinate more often), urgency (a strong desire to urinate), a decreased force of the urinary stream, and difficulty starting the urinary stream. Rarely, a complete blockage of urine may occur. If this should happen, you will need to see your urologist or go to the emergency room to have a catheter placed in your bladder to relieve the dis-comfort or blockage.
In most cases, the urinary side effects are moderate and resolve in a few weeks. The initial obstructive and irritative side effects are caused by inflammation and swelling from the implant. Delayed urinary symptoms often begin 7 to 10 days after the implant, and are due to the effects of radiation. Urinary symptoms may last for several days to a week or two; in a small percentage of patients the symptoms may last for several months.
Urinary symptoms usually decrease in intensity as the seeds lose their strength. Some patients require a catheter for several days and a very small percent require catheterization for a month or more.
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Rectal Symptoms
Rectal symptoms are relatively uncommon. Occasionally some constipation, diarrhea or small amounts of blood may occur. If these symptoms become bothersome, call your physician. It is a good idea to keep bowel movements soft. Drink plenty of fluids, eat fresh fruits and vegetables and include high fiber in your diet. You may take Metamucil, Milk of Magnesia, or other over-the counter laxatives if needed. These symptoms usually resolve as the radiation in the seeds decay.
Sexual Side Effects
Sometimes initial ejaculations may feel different, and the ejaculation may be temporarily discolored dark brown or black. These
Sexual changes should resolve over time. About 20% or men over 70 experience some impotence.
Radiation Safety Precautions
Radiation safety precautions should be taken in the presence of pregnant women and children.
It is possible that you could pass a seed when you urinate. In order to recover any dislodged seeds, we ask you to strain your urine for one (1) week to see if any seed are passed. Most often, if a seed is passed, it will occur in the first day or two after the implant. You will be provided with a strainer and a seed retrieval kit.
Abstain from sexual intercourse for two (2) weeks, followed by the use of a condom for two (2) weeks after the implant is recommended in the rare event that at seed is passed.
For those patients who are interested, there is available a lead lined undergarment called RadiationGuard.
Post Implant Guidelines
In the recovery room, a nurse will give you specific written instructions regarding your activities for the next few days.
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You will also meet with a member of our Medical Physics staff to discuss radiation safety precautions. The guidelines you will be given cover the following concerns:
Activity
You should avoid driving a vehicle for twenty-four (24) hours after your implant, because you have received general anesthesia. Heavy lifting and straining should also be avoided for two (2) weeks to prevent any bleeding or movement of seeds. You may bathe or shower any time after your implant.
Warm baths may ease any perineal discomfort that you experience.
Diet
A regular diet is suggested unless you are on a special diet for some other reason. Refer to the list a bladder irritants for foods that may increase bladder symptoms. While it is not necessary to eliminate these foods completely, you may wish to decrease the amounts consumed, especially if you are experiencing bladder symptoms.
These food and medications, may contribute to urgency and frequency of urination:
- Coffee (even decaf)
- Sugar and Honey
- All carbonated beverages Anything containing Caffeine Corn Syrup Tomatoes
- Citrus Juices and Fruits Tobacco Products
- Alcoholic Beverages
- Highly Spicy Foods Tea (even decaf)
- Chocolate
- Artificial Sweeteners
Diuretic effects of certain medications may cause a strong frequent urge to urinate.
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IMPORTANT POINTS TO REMEMBER:
You may have any or all of the items on the list. The key is moderation. A Five (5) to eight (8) ounce glass of total liquid per day is normal. Half of intake should be water (that’s about 40-64 ounces total fluid per day).
- Evenly distribute fluid throughout the day, rather than trying to catch up on fluid before going to bed. Limiting fluid intake after 7pm may help you sleep all night without getting up to go to the bathroom.
- Don’t limit fluid intake drastically. Concentrated urine can irritate the bladder.
- Excessive fluid intake contributes to urgency and frequency.
- Don’t wait too long between voiding. If an uncontrollable urge strikes three (3) hours after you have last voided, try a voiding schedule of every 2 1⁄2 hours.
- Sometimes, getting better requires a little more than changing habits.
Comfort
An ice bag may be used for twenty (20) minutes every two (2) hours for the first twenty-four (24) hours after implant for perineal discomfort. A warm bath may also help relieve perineal discomfort. Plain Tylenol or Extra Strength Tylenol (1-2 tablets) may also be taken for discomfort.
Urinary Symptoms
Due to swelling from the insertion of needles into your prostate, and the effects of the radiation on you prostate, you should expect some urinary symptoms. Urinary symptoms may include: burning, frequency, urgency, mild pain, a decreased urinary stream, a feeling of being unable to pass urine freely. These symptoms vary in severity among patients, and may last several days to a week or two. In a small percentage of patients, urinary symptoms may last a month or more.
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If you experience extreme or prolonged urinary symptoms, check with your urologist immediately. Blood in the urine should gradually decrease and disappear within forty-eight (48) hours. If you are unable to pass urine for six (6) hours or more, call your urologist or go to the emergency room if you cannot reach him. They will need to place a catheter to drain the urine and relieve your discomfort.
