Brachytherapy treatment
Summary: This involves the insertion of radioactive seeds into the prostate gland with needles placed through the skin beneath the scrotum
Contents:
- What does the procedure involve?
- What are the alternatives to this procedure?
- What should I expect before the procedure?
- What happens during the procedure?
- What happens immediately after the procedure?
- What should I expect when I get home?
- What else should I look out for?
- Are there any other important points?
- Is there any research being carried out in this field?
- Who can I contact for more help or information?
- Can I obtain a printed version of this information?
- Side effects & risks
What does the procedure involve?
This involves the insertion of radioactive seeds into the prostate gland with needles placed through the skin beneath the scrotum. This procedure may require telescopic examination of the bladder.
What are the alternatives to this procedure?
Active monitoring (watchful waiting), external beam radiotherapy, radical prostatectomy, laparoscopic prostatectomy, robotic prostatectomy & hormone therapy.
What should I expect before the procedure?
The day before your admission, you will be asked to take a laxative to clear the bowel.
You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse.
You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your Urologist in advance of your surgery if you have any of the following:
- an artificial heart valve
- a coronary artery stent
- a heart pacemaker or defibrillator
- an artificial joint
- an artificial blood vessel graft
- a neurosurgical shunt
- any other implanted foreign body
- a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
- a previous or current MRSA infection
- high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)
What happens during the procedure?
Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively.
You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
The procedure takes approximately 2½ hours. A catheter is passed into the bladder via the urethra (water pipe) and left in place until the following morning. An ultrasound probe is then inserted in the rectum and 15-30 needles are directed into the prostate through the skin between the anus and the scrotum (the perineum). The radioactive seeds, usually 60-90 in number, are then inserted along the needles into the prostate itself.
What happens immediately after the procedure?
A dressing will be placed between your legs, to reduce the swelling caused by penetration of the needles, and held in place by some elasticated pants. The catheter will be removed the day after insertion of the seeds.
The average hospital stay is 2 days.
What should I expect when I get home?
You will be discharged with mild painkillers and a 7-day course of antibiotics (Ciprofloxacin 500mg twice daily). Tablets to ease the flow of urine (alpha-blockers) will also be prescribed and usually need to be continued for a period of 3-6 months.
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
What else should I look out for?
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately.
Are there any other important points?
Women who are or may be pregnant should not sit close to you or on your lap for 3 months after seed implantation. The same precautions apply to children.
During the first few weeks after seed implantation, condoms should be used during sexual intercourse and disposed by double-wrapping them in aluminium foil and placing them in your dustbin. Seeds may, occasionally, be passed in the urine. If you see a seed in the toilet, try to retrieve it with a spoon or a pair of tweezers and dispose of it as above.
For specific advice relating to seed implantation, please contact the Brachytherapy Co-ordinator (Jo Treeby) on 01223 596330 or bleep 152-582 via the Hospital Main Switchboard (01223 245151).
Driving
It is your responsibility to ensure that you are fit to drive following your surgery. You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than 3 months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.
Is there any research being carried out in this field?
There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly Audit & Clinical Governance meeting.
Who can I contact for more help or information?
Oncology Nurses
- Bladder cancer Nurse Practitioner (cystectomy patients) -
01223 586748 - Bladder cancer Nurse Practitioner (haematuria, chemotherapy & BCG) - 01223 274608
- Prostate cancer Nurse Practitioner - 01223 216574
- Uro-Oncology Clinical Nurse Specialist (kidney patients) - 01223 257167
Non-Oncology Nurses
- Urology Nurse Practitioner (incontinence, urodynamics, catheter patients) - 01223 274608 or 586748
Patient Advice & Liaison Centre (PALS)
- Telephone +44 (0)1223 216756 or 257257
- PatientLine *801 (from patient bedside telephones only)
- E mail PALS
- PALS, Box No 53, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
Chaplaincy and Multi-Faith Community
- Telephone +44 (0)1223 217769
- E mail the chaplain
- The Chaplaincy, Box No 105, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
MINICOM System ("type" system for the hard of hearing)
- Telephone +44 (0)1223 274604
Access Office (travel, parking & security information)
- Telephone +44 (0)1223 586969
Can I obtain a printed version of this information?
Yes. You can print this Infosheet by using the print option on your browser or by clicking the "Print Infosheet" button at the top of this page.
If you wish to obtain the formal, printed version from Addenbrooke's or Hinchingbrooke, please contact your Consultant or Specialist Nurse.
To obtain this information in other languages, large print or audio format, e-mail Patient Information at Addenbrooke’s or telephone +44(0)1223 216032.
common Side-effects (greater than 1 in 10)
- Temporary insertion of a bladder catheter and wound drain
- Bruising and discolouration of the perineal skin
- Difficulty passing urine after the procedure (10-15%)
- Frequency and urgency of urination
- Need to self-catheterise temporarily whilst the swelling of the prostate settles
- Bloodstained urine for several days
- Impotence due to unavoidable nerve damage from the seeds (20-40%)
occasional Side-effects (between 1 in 10 and 1 in 50)
- Development of narrowing or strictures which may require surgery
- If the tumour does not respond completely, other treatment including surgery and/or hormonal treatment
- Rectal discomfort with discharge of blood or mucus from the anus
- Infection of the bladder requiring antibiotics
- Bleeding and swelling of the prostate preventing urination
- Urinary incontinence (temporary or permanent)
- Passage of the radioactive seeds in the urine due to migration of the seeds out of the prostate
- Occasional need for surgery to the prostate is there is persistent difficulty in passing urine
rare Side-effects (less than 1 in 50)
- Rectal damage requiring temporary colostomy
Hospital-acquired infection (overall risk for Addenbrooke’s Urology)
- Colonisation with MRSA - 0.14% (1 in 700)
- Clostridium difficile bowel infection - 0.04% (1 in 2500)
- MRSA bloodstream infection - 0.08% (1 in 1250)
(These rates may be greater in high-risk patients e.g. with long-term drainage tubes, after removal of the bladder for cancer, after previous infections, after prolonged hospitalisation or after multiple admissions)
