Common Questions

What is the difference between the radioactive isotopes Palladium-103 and Iodine-125 used in prostate brachytherapy procedures? Brachytherapy treatment involves implanting tiny, radioactive seeds into the prostate gland to fight cancer. Two different types of seeds are used. One has a palladium base; the other has an iodine base. A primary difference between the radioactive seeds is their half-life, or the amount of energy it expends. Palladium 103 emits its half-life within 90 days in comparison to Iodine 125 which expends its half-life in 12-18 months. Because Palladium-based seeds expend their half-life more rapidly, the side effects from the procedure may be more intense early on but tend to resolve faster than with Iodine-125.

If brachytherapy treatment is effective, why do some patients still have surgery?
Patients who are candidates for brachytherapy sometimes don’t hear much about this proven treatment because the physicians who diagnose their cancer are often trained as surgeons and, therefore, may be predisposed to perform surgery. In other cases, the physicians may have been educated before brachytherapy technology evolved or may not be familiar with the results of recent long-term studies regarding the effectiveness of this treatment.

Why do some patients receive external beam radiation in addition to brachytherapy?
Some physicians combine brachytherapy with external beam radiation therapy (EBRT) to escalate the overall radiation dose to the prostate gland. This technique is sometimes employed if patients have a higher risk of developing disease outside the gland.

Why do some patients receive hormone therapy in addition to seeding?
Hormone therapy does not cure prostate cancer, yet it can slow its growth by starving cancer cells of testosterone. It also can make cancer cells more susceptible to radiation treatment. Some doctors believe hormone therapy can shrink a prostate tumor, providing better overall treatment when combined with seed implants.

Is brachytherapy treatment right for me? To be a candidate for brachytherapy treatment, your cancer must be localized – or contained within the prostate gland. After this determination, your primary consideration is to cure the cancer. Long-term clinical studies prove cure rates are similar for localized prostate cancer patients treated with permanent seed implants, surgery and high-dose external beam radiotherapy (EBRT), as well as therapy combining seed implants and EBRT. Since cure rates for these procedures are similar, you’ll next want to examine how treatment may impact your quality of life. Typically, EBRT requires five visits to a clinic or hospital per week for six to eight weeks, and it exposes healthy tissues and nearby organs to potentially damaging radiation. Surgery requires a three- to five-day hospitalization and up to eight weeks of recovery.

Will my insurance cover brachytherapy treatment for my prostate cancer? Brachytherapy is one of the gold standards of care recommended by the American Urological Association. More than 650,000 prostate cancer patients  have experienced the benefits of prostate brachytherapy  treatment since it was introduced.  Medicare and most major insurance carriers cover this procedure. If you have questions about coverage, please contact your insurance carrier.

Can I have brachytherapy if I’ve had a transurethral resection of the the prostate (TURP)? If you have had a TURP, you may still be a brachytherapy candidate. A TURP changes the geography of the prostate gland and may interfere with uniform seed placement. In addition, the risk of incontinence is higher with patients who have had a TURP. However, recent data indicate “incontinence in patients with transurethral prostate resection has been relatively low at 6% or less” due to the adoption of newer seed planning and placement techniques.1 If you have had a TURP, your physician can best advise you about your treatment options.

I am interested in brachytherapy treatment. Who do I talk to? A cancer information specialist at the Theragenics® Prostate Cancer Information Center can provide more information, send you a free educational video and brochure, as well as help you locate doctors experienced with brachytherapy treatment. Call 1-800-458-4372 or e-mail us at cancerinfo@theragenics.com.

What will I feel like after the procedure? The procedure causes minimal trauma to the region beneath the scrotum, yet there can be some tenderness, bruising or swelling. Most patients require only over-the-counter pain medications. While some may be tired and want to relax, others feel like engaging in routine activities. As with all medical procedures, patient response varies.

When can I return to work?
Most men receiving prostate brachytherapy treatment with either TheraSeed® Palladium-103 or AgX100TM Iodine-125 return to routine activities — including work and exercise — within two to three days. Brachytherapy offers considerable benefits when compared to radical prostatectomy with an average recovery time of up to eight weeks.

What short-term side effects can I expect? Soreness and swelling usually go away after a few days. Some men may have blood in their urine for several days following the procedure. A small percentage may experience rectal irritation or bleeding. Others may feel discomfort while urinating or the need to urinate more frequently. The most commonly reported side effects are short-term urinary or obstructive symptoms within the first few weeks after the implant procedure. Some men may experience slight pain or blood in their semen during the first few ejaculations after the procedure.

These symptoms usually begin one to two weeks after implantation and gradually decrease over time as the seeds lose their radioactive strength. Drinking fluids and avoiding alcohol and caffeine may help, or a doctor can provide prescriptions to relieve these symptoms. For some men, nighttime urination will be more difficult because there may be slightly greater swelling of the prostate at night. Often, walking around relieves this problem.

Do I need to take special precautions after getting radioactive seed implants? Patients are not radioactive after this procedure. Because radioactivity in seeds is so low and placement so precise, virtually all radiation is absorbed into the prostate. However, a doctor may recommend special precautions when a patient is in contact with small children or pregnant women during the first few months following treatment. On the other hand, the risk to pets from sitting on a patient’s lap is extremely low. In addition, a patient may resume sexual activity shortly after the procedure, but his doctor may recommend avoiding sex or using a condom for the first few days in case a seed is ejaculated.

Will I need additional treatment after brachytherapy? As long as a patient’s prostate cancer responds well to treatment, additional therapy is rarely necessary. There is no need to remove the tiny seeds once they lose their radioactivity because the capsules are made of titanium, a material compatible with body tissues.

How will I know whether the procedure was effective? After treatment, the urologist and radiation oncologist perform follow-up tests, usually every three to six months for the first five years. These tests may include a digital rectal exam (DRE) and blood tests to measure PSA levels. A periodic ultrasound also may be performed to monitor progress. Malignant cells absorb the radiation, which damages the DNA and prevents them from dividing, thus causing cell death. Since prostate cancer cells often divide slowly, it may take a while for a PSA level to drop.

If the seed implants don’t work, what treatment options are available? In the unlikely event that brachytherapy does not cure a patient’s prostate cancer, several treatment options are available including a second seed implant procedure, external beam radiation therapy, cryosurgery and salvage prostatectomy.

 

1. Merrick GS, Wallner KE, Butler WM. Permanent Interstitial Brachytherapy for the Management of Carcinoma of the Prostate Gland. The Journal of Urology.2003;May;169:1643-1652.