First step is to submit the patient to transrectal ultrasound for calculation of prostate volume and estimation of disease extent. With the aid of a special nomogram table total dose to be implanted will be obtained and total number of "seeds" will be ordered.
Prior to implantation the patient is submitted to routine blood examination, electrocardiogram, chest X-ray and fleet enema (for emptying the rectum-last part of the bowel). Fleet enema will enhance visualization of the prostate through transrectal ultrasound. Implantation is performed in the operating room under spinal anesthesia by a specially trained team (urologist, radiation oncologist and physicist) and lasts around 60 minutes. A Foley catheter is inserted in the urinary bladder and ultrasound probe in the rectum, through which full image of the prostate gland will be visualized on the monitor.
"Seeds" (50-80 per patient) are placed with the aid of computer treatment planning software, through special needles that are inserted into the prostate via perineum (part of skin between scrotum and anus). Placement of the seeds is highly accurate because ultrasound guidance allows physician to visualize constantly the exact position of the needle in the prostate gland. The number of needles and "seeds" differs from patient to patient and depends on the size of the prostate.
Patient is discharged from the hospital the same or the next day of implantation and resumes his normal life activities. The following days after operation he may experience: 1) a small edema or bruise around perineal region and 2) frequent urination or burning sensation during urination. All symptoms will resolve after a few days. Rarely patient may notice blood drops or slight hematuria during first days following implantation that will resolve spontaneously. Urinary retention is a rare complication (3-5% of patients) and usually resolves after medical administration prescribed by your urologist. No patient will experience urinary incontinence. Sexual function is retained in more than 80% of the patients.
The majority of activity wears off after 4-6 months and the "seeds" remain permanently in prostate gland causing no discomfort.
Image of transrectal ultra sound (sagital view) showing seeds placed in prostate and seminal vesicles.