Seed Implantation Revisited

Christopher Lukas Health Guide October 27, 2006
  • I had lunch with Zack yesterday. In ten days, he’ll get his seed implantation (brachytherapy); he’s been having some anxiety about it, but nothing he can’t handle. The hormone shot he had in July gave him a diminution in sex drive, and I thought that would make a good reason to revisit the whole question of seed implantation.

    If you go on-line, there are lots of sites that can offer you differing views of that mode of treatment. Some are associated with centers that offer brachytherapy, others are not. I always tend to trust the independent sources more than the other, but there are some things on which they both agree.

    First of all: seed implantation now comes in two different varieties. There is the kind that plants them permanently in various parts of your prostate, using tiny needles to do so (while you’re under local anesthetic, of course). The other (often used in combination with the first), uses catheterized needles to give radiation in specific dosages and spots, but then withdraws the needles, so the seeds aren’t left in your prostate.

    Second: the permanent seed implantation takes a few hours, after which you can go home. The temporary implantation is done over about 24 hours in the hospital, though this is not common.

    Third: While different men will have different kinds of side effects from both treatments, some soreness is expected after the anesthetic wears off. Some minor bleeding may occur. Minor is the operative word. There may be some of the following, too:

      a. An urgent need to urinate. A slow stream. A hesitant stream. This initial spate of urinary problems will go away, but return after 2-4 weeks, because the radiation from the seeds will be causing some irritation. This, too, will disappear, but patients sometimes get worried if they’re not expecting it. After two months, all urinary problems should be gone.
      b. Sexual activity can be affected. Erections may be less strong. Ejaculation may be smaller. Some doctors recommend patients who want children after brachytherapy to use a sperm bank before the treatment. There may be some pain (stinging) with orgasm, due to the irritation caused by both needles and radiation. This, too, should decrease very shortly (a few weeks) after treatment.
      c. Seed “migration.” This happens rarely, and usually it simply means that one or more of the seeds travels outside the prostate—into the urethra or bladder. Physicians say to use tweezers to pick up the seed and put it in aluminum foil and dispose of it. Because of this possible migration, doctors suggest that sexually active men masturbate for the first few sexual events, rather than risk transmitting the seed to a partner—though clearly, you will want to use condoms whenever possible!
      d. One of the usually un-discussed side-effects is a little different. Zack told me that he had been cautioned not to hold his grandchildren on his lap until three weeks had passed. This is because some modest amount of radiation could carry through from his prostate to the children. It’s certainly not a problem kissing or hugging, or having conversations with young children, but lap-holding should be avoided for a while.



  • So, what about seed implantation? Should you choose it over external radiation or surgery? Looking back, I think I should have done so, because it’s much more convenient, less likely to lead to impotence or incontinence, and can do just as much good as the other treatments.

    Also: I was a good candidate for the treatment, which is recommended for patients whose prostates aren’t huge, who have early-stage cancer, whose PSAs are below 10, whose Gleason scores are lower than 7. That’s a hell of a lot of patients, by the way!

    One more cautionary note for those undergoing brachytherapy. Your PSA might rise shortly after the therapy. That’s not a bad sign. It’s simply a result of the procedure and the radiation.

    Learn more about sexual side effects associated with treating prostate problems at our ED website, ErectileDysfunctionConnection.com.

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