The London Bridge Urology department are pleased to announce the launch of Brachytherapy in March 2009 (A popular alternative to surgery and radiotherapy for patients with early, localised, prostate cancer) for further details please see below:
What is Prostate Brachytherapy?
Brachytherapy is radiation treatment that is given inside the patient, as close to the cancer as possible. The radiation is delivered inside the body with radioactive isotopes (chemical elements), inside delivery devices such as wires, seeds, or rods. These devices are called implants. The radiation dose is concentrated on the cancer cells and less damage is done to the normal cells near the cancerous growth.
Prostate brachytherapy is used to treat localised prostate cancer. This means the cancer has not spread outside of your prostate gland. It involves using permanent implants called pellets or seeds. These implants are very small, about the size of a grain of rice. Needles are inserted directly into the prostate through the skin between the scrotum and rectum (perineum). The seeds are then injected through the needles into the prostate. The implants are left in place after the radiation has been used up, as their small size causes little or no discomfort.
State-of-the-art computer planning software in the operating suite is used to analyse the implant for correct seed placement to ensure the radiation dose cloud is exactly shaped to the prostate.
The procedure is carried out in two stages, with stage one being the volume study and stage two the implanting of the seeds. The two procedures are very similar except during the volume study there are no needles used. This is a detailed transrectal ultrasound study done with the patient in the implant position. During the volume study, a catheter is inserted in your urethra whilst under anaesthetic. This helps to identify the urethra during the procedure. It will be removed afterwards. During the study the prostate volume is outlined on the ultrasound images. A series of ultrasound pictures are of the entire prostate volume. A three- dimensional model is then constructed by the brachytherapy planning computer and a dose plan produced.
This plan will be unique to each patient and will determine the position and number of seeds needed.
Brachytherapy is a very effective treatment for early prostate cancer, with patients quickly returning to normal activities.
WHAT ARE THE RISKS?
Urinary frequency and urgency: 80% of patients have mild symptoms and 20% have symptoms that are moderately severe. Symptoms usually peak 6-12 weeks after brachytherapy and improve after this. It is important to drink plenty of clear fluids and try to avoid caffeine and alcohol as these will aggravate your symptoms. Urinary retention (unable to pass urine): this is unusual, but is more likely if your prostate is large and swells after treatment. If this happens you will have to have a catheter inserted into your bladder to drain the retained urine. We can also try to teach you to catheterise yourself, using a single use catheter. Some patients find it easier and more convenient; this avoids having a permanent indwelling catheter. This will only be for a few weeks; then you will find your bladder is emptying properly again.
Problems getting or maintaining an erection: 20% of patients may have erectile dysfunction for around six months. This can be treated effectively with medication.
Fertility: brachytherapy does not leave you sterile, unlike other radical treatments. The seeds remain radioactive for about a year after implantation. We recommend that you and your partner use contraceptive for a year after your treatment to avoid pregnancy.
Rectal bleeding, pain/ inflammation of the back passage: 2.5% of patients may experience this. If you have rectal bleeding you must contact us so we can advise you on what to do.
THE DAY OF THE IMPLANT:
What will happen?
The procedure is usually a day case, however it is advisable to come prepared for an overnight stay.
You will check in at the Main Reception Desk. Staff from the Inpatient Accounts Department will greet you and check your registration and payment details.
Once check-in has been completed you will be escorted to your room. You will then meet the nursing staff who will be caring for you.
You will need to have an enema prior to the treatment, you will be able to administer this yourself prior to coming into hospital if for some reason you are unable to this will be done by the nurse who’s looking after you.
The Consultant who is responsible for your care will see you to consent you for the operation and the anaesthetist will also see you to discuss the anaesthetic.
A general anaesthetic is usually given.
The implant procedure will take approximately one and a half hours.
AFTER THE IMPLANT:
After your doctor has implanted the seeds, you will be taken to a recovery room. You will stay there until you come around from the anaesthetic.
When you wake up you will have a drip in your arm connected to a bag of fluids which will keep you hydrated. When you first go to pass urine it may be a little uncomfortable at first. If you have problems with this you may need a catheter inserted, only under 2% will need this. Also each time you urinate your urine will be checked for any seeds. Most patients experience little or no discomfort after the procedure. Pain relief will be prescribed if you need it. Normally anti-inflammatory painkillers are prescribed which are very effective and also help in reducing the swelling of the prostate.
It is important to remember if family come to visit you while in hospital, and for when you go home, that anyone pregnant should not sit very close to you. You can continue to greet and hug people as you would do before. Do not sit young children on your lap for at least the first 2months. You can briefly hug them and cuddle them. Other adult family members and friends are not at risk, only foetuses and young children may be affected by low levels of radiation.
You should be able to leave hospital within 6 to 12 hours post procedure.
Before leaving you will be given a brachytherapy advice card, which states that you have had treatment with internal radiation. This has emergency contact numbers which you can call anytime. This card should be kept with you at all times especially if you are travelling abroad. The radiation in the seeds can set off the airport radiation sensors.
You will be sent home on some antibiotics for 1 week or more. This will help to prevent any infection occurring following the implant.
You will also be started on a tablet which relaxes the muscle within the prostate which will help with your urinary symptoms. This is called an Alpha-blocker such as Tamulosin (Flomax) or Alfuzosin (Xatral)
As a general rule, you will be able to return to normal activities (e.g. work, shopping) within 2-3 days. However you should be careful and try and avoid anything too strenuous, or heavy lifting for a few weeks following the implant. This can cause you to pass some blood in your urine. If you notice your urine is a little blood stained this should clear in a few days. If it gets very bloody and clots are present and you’re having difficulty in voiding, Please seek urgent medical advice.
You may have some bruising beneath the scrotum and tenderness between the legs. This will gradually go away.
You should drink plenty of clear fluids 2-2.5 litres per day, avoid caffeinated drinks and alcohol.
Some patients find that following the implant, their bowels tend to be a little constipated. This can usually be relieved by increasing your fibre intake, plenty of fresh fruit and vegetables.
Sexual intercourse, using a condom, may be resumed after 1 month, once you feel comfortable to do so. Initially a condom should be used, because there is a very small risk that a seed may be passed in the semen. Your semen may be discoloured a dark brown colour. This is normal and is a result of bleeding that may have occurred.
If you develop a temperature greater than 38.0c this may indicate an infection.
Again seek urgent medical attention.
FOLLOW UP APPOINTMENTS
An appointment will be made to see your urologist at 2 weeks post implant.
An appointment will be made for a follow up CT scan 4 weeks post implant. This will check the seed positions in the prostate now that the swelling post treatment has reduced.
A chest x-ray is performed to ensure that no seeds have travelled to the lung. However this is uncommon and causes no adverse side effects or problems.
6 weeks post implant an appointment will be made with your Oncologist who will discuss and review your implant procedure.
A follow up PSA blood test will be done at 11 weeks.
And at 12 weeks you will have an appointment with your consultant to discuss the results.
HOW TO CONTACT US
If you would like some more information or advice please contact Edna Dwyer (Urology Nurse Specialist) on
0207 234 2366 direct extension or via the switch board on 0207 407 3100 and get them to bleep 037.
Also you can contact the Urology Practice Manager at London Bridge Hospital Nikki Lewis on 0207 357 6466 if you wish to arrange an appointment or speak to your Consultant.