Prostate Seed Implant

prostate-seed-insetProstate Brachytherapy, also known as a Radioactive Transperineal Prostate Seed Implant, is another method of delivering radiation using radioactive seeds implanted into the prostate. This form of therapy delivers photon radiation from the “inside-out,” as opposed to Intensity Modulated Radiation Therapy or Image Guided Radiation Therapy, otherwise known as IMRT/IGRT, which delivers radiation from the “outside-in.”

How is the seed implant performed?

Seed implants are performed as an outpatient procedure at one of several hospitals or at the Advanced Radiation Centers multi-purpose facility in Lake Success. The procedure is usually done with both your Urologist and Radiation Oncologist working together.  When you arrive for your appointment, the nursing staff will make you feel at ease. First they will see if you have any unanswered questions and prepare any paperwork; next you will meet with the Anesthesiologist. After you are comfortable, you will be taken to the procedure/operating room where you will be prepared for the procedure and given anesthesia. Once you are comfortably asleep, your Radiation Oncologist will begin the procedure by measuring the exact volume of the prostate in the treatment. Your doctor will then calculate the radiation dose needed based on that volume. Often this is done using a computerized planning system, which enables a 3-dimensional dose calculation. Once the number of seeds required has been calculated (which is typically between 30 and 130 seeds), the procedure can begin.

The Seed Implant process begins with your doctor placing small needles into the prostate gland through the perineum, which is the skin between the scrotum and the anus. The procedure is performed using real-time visualization of the prostate using an ultrasound probe that is placed in the rectum. Once a needle has been placed into the proper position within the prostate, the Radiation Oncologist is able to inject or “load” several radiation seeds through that particular needle, placing each one in an exact location.  That needle is removed, and another one is placed in a slightly different but specific position. Once this needle has been loaded and seeds delivered, the same procedure continues until the entire prostate has been implanted with the appropriately determined number of seeds.

Once the procedure is completed, and before the anesthesia is reversed, the Urologist will perform a cystoscopy, where the doctor is able to take a look into the bladder using a special scope inserted through the urethra. This brief examination confirms that no seeds may have been inadvertently placed into the bladder, and if they have been, the Urologist can remove them. The general health of the bladder walls is also inspected at this time. Once this process is completed, the Urologist may place a Foley catheter into the bladder through the penis, to allow urine to drain without possible obstruction, which can be caused by swelling that was introduced during the procedure.  Next you are taken to the recovery area where you will rest until you wake and are more comfortable; that could be up to an hour or two, if necessary. The Foley catheter may be removed prior to your going home, in which case the nursing staff will want to make sure that you are urinating on your own, or, the physicians may decide to send you home with the catheter, in which case, instructions on how to empty the collecting bag will be provided. In this case, the catheter would typically be removed in the next day or so, either at the urologist’s office, or at home with previously provided instructions.