Prostate seed implantation is a highly successful treatment option for localized prostate cancer. Over the last twelve years, it has become one of my preferred methods of treating prostate cancer. During that time I have personally performed almost three hundred seed implantations in conjunction with a radiation oncologist.

Seed implantation (also call prostate brachytherapy) is typically performed as an outpatient. It can be easily managed in a hospital or even in an outpatient ambulatory surgery center. Typically the patient will go home with an indwelling catheter to drain their bladder. All of my patients remove their own catheter the morning after the procedure. There are two main techniques used and they are both successful. Each urologist or radiation oncologist will have his or her bias as to which is best. What is most important is their long term results.

Most seed implantation is done with either radioactive Iodine or Palladium. There are other isotopes used, but these two comprise the bulk of the seed implants performed in the United States. The choice between the two is dependent upon a number of factors, not the least of which is preference of the radiation oncologist.

About one week before the seed implant I meet with each patient (and often their spouse) to discuss the procedure and give them all of the prescriptions that they will need for before, during and after the procedure. The day prior to the seed implantation, my patients will undergo a bowel preparation similar to that done for a colonoscopy.

My typical seed implant takes less than an hour to complete from after induction of anesthesia to wheeling the patient to the recovery. Patients are placed in a position similar to that of a woman bearing a child. An ultrasound probe is placed in the rectum and ultrasonography of the prostate gives a very precise picture and size of the prostate. Based on these pictures the radiation oncologist determines the number and distribution of the seeds. Typically the urologist is responsible for the ultrasonography and placement of the hollow needles through which the seeds are dispensed. How many seeds each man gets is immaterial. What is important however is that a full dose of radiation is given and that it is done so in a way that spares the effect of radiation on the urethra (voiding channel) while allowing for full effect on the prostatic tissue.

After removal of the catheter my patients will take an antibiotic for a few days. Every patient is placed on a short course of steroid because they have been shown to decrease the risk of urinary retention after seed implantation. Almost all of my patients will be on a medicine such as Flomax to help with their urination after the seed implantation and this will typically be continued for about three to six months.

The most common side effects after seed implantation is discomfort with urination, slowing or the urinary stream, urinary frequency and increase in the number of times a night the patient urinates. Erectile dysfunction is more common in men that have marginal erections to begin with but in general, I have found it to be less likely than with radical prostatectomy.

In men with low risk cancer, it has been my experience that seed implantation is highly successful. Men with higher risk disease will often need adjunctive therapy such as a boost of external beam radiation or hormonal therapy, but the majority of men fall into the low risk category.

When I first started performing seed implantation, I would reserve it for the older rather than the younger men. After a couple of years of experience, I realized that seed implantation, in my hands, was as successful as surgery and this has now been borne out for the last twelve years. If you believe that radiation from seed implantation kills prostate cancer, then age really should not make a difference. What I have found that restricts seed implantation is the higher rate of complications in men who have had prior prostate surgery such as a TURP, or men who have very poor voiding function at the outset.

My youngest patient to have undergone seed implantation was 47 years old at the time of his implant. He is a black male with a family history of prostate cancer. This was very early in my “seed implant career,” and I tried very hard to talk him into a radical prostatectomy. He has just turned sixty years of age and his PSA is undetectable. Each year that he comes to see me for his exam he reminds me that I tried to talk him into surgery and how happy he was that he did not get a radical prostatectomy. As you can see, the patient often knows better than the doctor and I happily tell him that he made the right decision for him so many years ago.

Obviously you can see that I have a bias toward seed implantation. It has worked well for my patients and the side effect panel and complication rate is, in my mind, better than that of surgery. Each patient needs to pick what is right in his case, but my feeling is as follows: If we have a procedure that works well, doesn’t require a long recovery, and has a less morbid side effect panel then we should use it. It seems that many of my colleagues agree as seed implantation has become the most common radiation treatment for prostate cancer and has challenged if not surpassed radical prostatectomy as the most requested treatment for low risk disease.

Have a great week.