Prostate Brachytherapy

Treatment — Prostate Brachytherapy

Radioactive Iodine-125
Seed® Implant

Information for Patients

Introduction
This booklet describes the Radioactive Iodine-125 Seed®
Implant. It is one treatment option available for some menwith early stage prostate cancer.
There are many methods of treating prostate cancer. In
consultation with your doctor, choose the option that is bestfor you.
Visit www.decisionhelp.qcancercare.com to explore youroptions for prostate cancer treatment.
If you are having your implant done in Calgary, The Rapid
Access Clinic (RAC) information session at the Rockyview
Hospital can help you make this decision. Call 403-943-8888
or visit prostatecancercentre.ca/our-programs to find the next
information session.
Prostate Brachytherapy with External Beam
Radiation Therapy
Sometimes for more advanced prostate cancer, acombination of brachytherapy and external beam radiation
therapy is used. Your Radiation Oncologist will talk to you if
this is an option for you.

Questions about Treatment
If you have questions or concerns about yourtreatment, call:
Brachytherapy Office (Mon to Fri 8 am – 4:30pm)• Calgary• Edmonton

403-521-3955
780-432-8475

Table of Contents
A Internal Radiation Therapy................................11) Radiation therapy
2) Prostate brachytherapy

B How is the Implant Done?.................................31) Radioactive Iodine-125 Seed®
2) Ultrasound probe and treatment plan

C How do I Prepare for My Implant?....................5
D Radiation Safety After Your Implant................61) Radiation precautions
2) Medical treatment after your implant

Managing Your Symptoms

E After the Implant................................................81) Precautions after your implant2) Possible short term side effects
3) Possible long term side effects

F Frequently Asked Questions..........................12
G For More Information.......................................14
1) Prostate gland
2) Prostate cancer3) Support groups

AInternal Radiation Therapy1) Radiation therapy
Radiation therapy is a treatment for cancer that works bydestroying cancer cells, stopping them from growing anddividing.
Radiation therapy can be external (outside) or internal(inside). External radiation comes from outside the body andis aimed at the tumour. Internal radiation happens when aradiation source is placed in the body, either inside thecancer, or close to it.
Brachytherapy means “short distance” radiation therapy.
This means the radiation source is close to or inside thepatient. Prostate brachytherapy is a form of internal radiation
therapy and is performed by carefully placing radioactive
Iodine-125 Seeds® inside the prostate gland.

2) Prostate brachytherapy
You could hear several ways to describe prostatebrachytherapy:• Interstitial or internal radiation therapy• Brachytherapy• Seed implant• Iodine-125 Seed® implant
During the procedure, small radioactive Iodine-125 Seeds®
are placed inside the prostate gland. Over time, the seeds
release radiation into the prostate gland. There will be noradioactivity left in the seeds after 20 months(1 year and 8 months).
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What do I need before having prostate brachytherapy?
• A blood test to know your PSA (prostate specific antigen)level• A biopsy to know your Gleason score (a rating system forprostate cancer). Visit www.bit.ly/CCSGleason to learn
more.
• A CT scan or transrectal ultrasound to know the size ofyour prostate.
• A visit to the pre-admission clinic to assess your general
health and ability to have anesthetic.
• Other tests may be requested by your doctor.
Is prostate brachytherapy an option for me?
Prostate brachytherapy may be an option if you have a:• PSA level of 20 or less.
• Small prostate gland. Sometimes medications can shrink
the prostate if it is too big. Your Radiation Oncologist willtalk to you if this is an option.
• Gleason score of 7.0 or less.
Prostate Brachytherapy with External Beam
Radiation Therapy
Sometimes for more advanced prostate cancer, acombination of brachytherapy and external beam radiation
therapy is used. Your Radiation Oncologist will talk to you if
this is an option for you.
Will the implant cure my prostate cancer?
In many cases the seed implant will destroy all the cancer
cells in the prostate. In other cases, the seeds help slow
down the growth of cancer cells.

2B

How is the Implant Done?

1) Radioactive Iodine-125 Seed®
The seeds are very small, and look like a grain of rice. Below
is a picture of some Iodine-125 Seeds® next to a penny.

Other things to know:• The number of seeds placed inside your prostate depends
on the size and shape of your prostate.
• The seed implant is done in the operating room undergeneral anesthetic (you will be put to sleep).
• This is a day procedure. You will spend time in thedepartment preparing for your implant, having your seeds
placed, and recovering from the procedure.
• Some patients will stay in the department until they canpee (urinate) on their own (without a catheter).
• An ultrasound probe is used to place the seeds (see nextpage). This probe will be placed in your rectum during theprocedure. In some clinics, this is also needed for thedoctor to plan your treatment.

32) Ultrasound probe and treatment planYour treatment is planned so that your prostate gland will geta certain amount of radiation. The plan also keeps theamount of radiation to the tissues around your prostate low.
Brachytherapy treatments are sometimes planned before you
implant, and other times are planned during your implant.

Surgical needles

4CHow do I Prepare for My Implant?

There are several steps to help
prepare for your implant procedure.
See your “Preparing for Prostate
Brachytherapy Implant” handout forthe steps at your cancer centre.
If you use a calendar at home oron your phone, write these
instructions down on the dates youneed to do them, to help remind
yourself.

Visit the Pre-admission Clinic
If you have not been seen by the Pre-admission Clinic,
call your Brachytherapy Office:403-521-3955
780-432-8475• Calgary• Edmonton

5DRadiation Safety After Your Implant1) Radiation precautions
There are a few things to consider in the 2 months (60 days)
after your implant. Try keeping an “arms length of distance”
between you and other people, especially children andpregnant women. It is okay to hug.
Sharing a bed• Sleeping in the same bed with your partner is safe.
• Place a pillow between you for 2 months (60 days) tokeep some space between you while sleeping.
Sitting and Visiting• You can visit and hug people after your implant.
• Avoid having pets or kids sit on your lap for 2 months(60 days) after your implant.
Sexual Activity• Do not have sex for 2 weeks (14 days) after your implant.
• Use a condom during sex for 2 – 4 weeks (14 – 28 days)
after your implant.
Travel
• Avoid travel by airplane or bus for 1 month (30 days)
after your implant. If you must travel, try to keep yourtravel time 3 – 4 hours or less. Try to get up and walkaround during your trip.
• Keep a seat between you and the person closest to you.
• Carry your Blue Wallet Card at all times for the next
20 months (1 year and 8 months). You will get this cardafter your implant.

6Will I set off the airport security detectors?
Yes. For 20 months (1 year and 8 months) after your implant
you could set off radioactivity devices in some airports orborder crossings. You could also set off sensitive metaldetectors.
• Carry your Blue Wallet Card and be ready to show it tosecurity.
• The first time you fly or cross the border, give yourself
extra time. Security guards will need to verify yourmedical procedure.

2) Medical treatment after your implantIf you need future medical treatment, especially abdominal
surgery, the doctor may wish to have information about yourimplant.
• Call your Radiation Oncologist to discuss any concernsthat might relate to your future treatment.
• If needed, your Radiation Oncologist can discuss any
concerns with your doctor.

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EManaging Your Symptoms
After the Implant

1) Precautions after your implantFor
2 Weeks • Sit down to urinate to help you relax(14 days) • If a seed comes out, flush it down the toilet
DoFor• Lift anything over 10 pounds
6 Weeks• Ride a bike, stationary bike, or ride horses(42 days)• Ride a motorcycle
Don’t
If a seed comes out while you urinate (very rare)• Flush the seed(s) down the toilet. The amount of radiationfrom one seed is very low. This will not affect yourcancer treatment.
• Call the brachytherapy office to let them know.

2) Possible short term side effects
Changes to Urinationa) A burning feeling may happen if you do not drink enoughfluids (like water, unsweetened cranberry juice). Avoid
alcohol and caffeine (like tea, coffee, and cola).
b) You may urinate more slowly. Relaxing as much as
possible and sitting on the toilet can help. Your Flomax®
prescription will help relax your muscles and improve yoururine flow. It can take a few months for this symptom toimprove.

8c) Urinary Obstruction
For 1 out of 20 patients, urine flow may stop completely (youcannot pee). If this happens a catheter can be inserted into
your bladder for a short time until you can urinate again.
Go to the nearest Emergency Room if:• You are unable to urinate for 5 to 6 hours or moreOR• You are still urinating, but have a feeling of
discomfort and fullness in your bladder, ordiscomfort or pain in your lower back. You may not
be emptying your bladder fully.
d) Infection• Your Ciprofloxacin® prescription will help prevent
infections. Take it as prescribed.
Go to the nearest Emergency Room if:• You have burning or pain while you urinate• Your urine smells bad or is cloudy• You have fever and chillsf) Fatigue can happen, but is not very common. Light tomoderate exercise can help. Ask your cancer centre forresources on “How to Manage Cancer-Related Fatigue”.

9g) Sexual Activity• Sexual function can vary after the treatment. It may taketime before your sexual function returns to how it was
before the implant. You may need medication. Talk to yourRadiation Oncologist for more information and ask for a
copy of “Sexual Health for Men” from your cancer centre.
• Because the prostate gland produces fluid, many men will
notice less ejaculate (fluid/semen) after the procedure.
This is common and normal.

3) Possible long term side effectsThe urethra is the tube that carries urine (pee) from thebladder, and out through the tip of the penis. Sometimes theurethra can become more narrow because the:• treatment might cause the prostate to swell• radiation can “scar” the urethra.
If the urethra gets more narrow, it can cause you to:• urinate more often• have difficulty starting to• feel an urgent need to urinate urinate• have burning when• have difficulty emptying
you urinate
your bladder
A Urologist can treat this by stretching the urethra. For somepeople, a surgery may also be needed.
Tell your Radiation Oncologist if this happens
before you have any kind of treatment.
10b) Incontinence (unable to hold your bladder)• This is rare after the implant. Talk to your Radiation
Oncologist if this happens.
• Underwear liners or pads (like Depends®) can help.
c) Rectal Bleeding• This can happen from radiation scar tissue forming in therectum.
• Try changing your diet by adding more fiber.
• Sometimes scar tissue is removed with a laser.
Sometimes major surgery may be needed to if you have
had additional biopsies or treatments.
Tell your Radiation Oncologist if this happens
before any treatments start.
d) Impotence (inability to get an erection)• 1 – 3 men out of 10 may develop this up to 5 years after
their implant.
• Medications like Viagra® and Cialis® can help.
• If medications don’t work, other options are available. Talk
to your Radiation Oncologist.
e) Infertility (unable to have a child)• Your fertility may be reduced. Having treatment close to
your testicles can reduce the number of sperm or theirability to fertilize an egg.

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F

Frequently Asked Questions

How many seeds will be implanted?
Everyone’s treatment is different. On average 60 to 120
seeds can be used, depending on the size of your prostate.
How do you get the seeds into the prostate?
Needles are inserted through the skin between the scrotum
and the rectum. The needles are hollow, and allow the seeds
to pass through the needle and be placed into the prostate atspecific locations.
What happens to the seeds over time?
The Iodine-125® Seed implant is permanent. The seeds will
always be in your prostate gland. The level of radiation
decreases over time. After 20 months (1 year and 8 months)
no radioactivity can be detected.
What should I bring to the hospital?
Bring your health care card, government ID, and someone todrive you home.
What if I need a place to stay before the implant day?
There are several hotels and motels close by.
• In Calgary you can stay at the hospital hostel. To reachthe hostel, call 403-944-1156. You can also pick up a“How to Find Accommodations In Calgary” booklet.
• In Edmonton you can call the Cancer Information Centre
at 780-432-8456 to get a list places to stay near by.
Will I be radioactive?
No. The implanted seeds are radioactive, but you are not.
Most of the radiation stays inside your prostate. The risk ofthe radiation affecting anyone else is small.

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Who is a part of my brachytherapy team?
• Radiation Oncologist – a medical doctor who treats
cancer using radiation.
• Medical Physicist – a specialist of medical physics whohelps plan the treatment and ensures the quality of theimplant.
• Radiation Therapist – delivers radiation treatments, andhelps you before, during and after the implant.
• Dosimetrist – a radiation therapist specializing in thetreatment planning for radiation.
• Anesthesiologist – a medical doctor who provides you
with care during your implant and recovery. They may talkto you about the medications you take before and after
the implant.
• Nurse – may assist in the operating room and during yourrecovery.
• Ultrasonographer – a technologist trained in ultrasoundto produce pictures of your prostate gland and anatomy.
How am I followed by my doctor after my implant?
• You will have a follow-up appointment 4 weeks after theimplant.
• This may include a CT scan or a Chest X-ray.
• Your Radiation Oncologist will continue to see you. Write
the dates of your next appointments below.

13G

For More Information

1) Prostate gland
The prostate gland is part of the male reproductive system.
Its main function is to produce the fluid portion of semen. The
size of the prostate can vary among men, but it is usually thesize of a large walnut.
It is located just below the bladder near the internal base ofthe penis. The prostate surrounds the urethra, the tube thattransports urine from the bladder and out through the penis.
The prostate gland secretes its fluid into the upper part of theurethra during ejaculation. This fluid helps to transport spermout of the penis. The prostate gland slowly increases in size
from birth to puberty. Enlargement of the gland may occur
after age 45.

142) Prostate cancer
In a healthy body, new normal cells grow to replace old cells.
Genes inside each cell instruct it to grow, function, reproduce
and die according to a plan.
For many people, this process continues normally throughout
their lives. But in some people, some cells begin to reproduce
abnormally because the instructions become confused.
Groups of abnormal cells can grow together and form
tumours.
Prostate cancer is usually slow-growing. It can develop overa long period of time without showing any symptoms. As itgrows, it can put pressure on the urethra, making urinationdifficult, slow or painful. Prostate cancer can be detectedusing many different tests.

153) Support groups
Support Groups
Support groups give those living with cancer an opportunity
to interact with others in similar situations. Some are led byhealth care professionals while others are led by community
members, in person or online. Find out more by calling
Psychosocial Oncology:• Calgary (South) 403-355-3207• Edmonton (North) 780-643-4303
Prostate Cancer Canada
The Prostate Cancer Canada website has information forpeople who have been diagnosed with prostate cancer andtheir families including information on support groups. Visitwww.prostatecancercentre.ca or call 1-888-255-0333 to findout if there are prostate cancer support groups in your area.
Canadian Cancer Society — Peer Support Program
It can be helpful to talk with someone who has also had
prostate cancer and finished treatment. The CanadianCancer Society’s Cancer Connection program is a support
network that offers peer-to-peer support to cancer patientsand their caregivers. You can talk with caregivers or current
and former patients with your same type of cancer. Call
1-800-263-6750 or visit www.cancerconnection.ca.
Prostate Cancer CentreCalgary’s Prostate Cancer Centre (PCC) has programs formen and their family members dealing with prostate cancer.
The centre provides diagnostic services, educational
resources, information sessions, post operation care andresearch. Call 403-943-8888, email
info@prostatecancercentre.ca, or visit
www.prostatecancercentre.ca for more information.
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Cancer Patient Education

Treatment│Prostate Brachytherapy│PROV | 2016│B0097