Using sophisticated ultrasound and computer technology between 60 and 120 radioactive seeds are inserted into the prostate gland.

Low dose rate brachytherapy is performed by Dr Swindle and also Dr James Mackean, a radiation oncologist, together at the same time. Dr Swindle performs the surgical part of the procedure and Dr Mackean performs the technical part associated with calculations of radiation dose and seed placement.

There are 2 techniques for inserting radioactive seeds into the prostate gland. One technique involves a single stage procedure and is called “intra-operative realtime prostate brachytherapy”. The other technique involves a 2 stage procedure and is called “preplanned prostate brachytherapy”. In the preplanned technique patients are taken to theatre approximately one or two months before the actual implant and a “volume study” is performed. This entails taking multiple images of the prostate using a transrectal ultrasound probe. These images and then analysed using sophisticated software and the exact placement of every seed, is calculated and planned. On the day of the actual implant, the patient is taken back to theatre for a second time and the seeds are then inserted into the prostate according to the plan.

In contrast to the two stage pre planned technique which requires two visits to the operating theatre, the intra-operative real time prostate brachytherapy is a one stage procedure and requires only one visit to the operating theatre. During intra-operative real time prostate brachytherapy, a transrectal ultrasound is used to image the prostate a three dimensional image of the prostate is created. Whilst the patient is asleep in theatre sophisticated computer software is then used to calculate the exact placement of each seed.

Multiple needles are then inserted into the prostate gland, through the skin between the scrotum and anus (perineum), under ultrasound guidance according to specific co-ordinates. A robotic delivery system is then connected to each of the needles which then delivers each seed precisely to a predetermined position whilst being monitored by ultrasound. This procedure takes between 90-120 minutes.

What to expect following Low Dose Rate Brachytherapy

After the procedure, you will be taken to the recovery unit where regular observations (your blood pressure and pulse) will be taken by a nurse until you have recovered from the anaesthetic and fully woken up. You will have a drip in your arm and also a tube (catheter) in your bladder to drain your urine. This is usually removed early the next morning, provided the urine appears clear and is not too blood stained. Your perineum may be slightly bruised and an icepack to this area can help relieve any discomfort.

You will stay in hospital over night and the catheter is removed at 6am the following morning. Once the nursing staff are happy that you are passing your urine adequately you will be discharged. When you are discharged from hospital, you will have the following medications:

Flomaxtra or Xatral:

These medications are known as alpha blockers and relax the smooth muscle surrounding the prostate and bladder neck. They make it much easier to pass urine and can counteract the difficulty in passing urine that some men have after brachytherapy due to swelling of the prostate from the procedure.

Either of these medications will be prescribed for you at your preoperative consultation with Dr Swindle. You will be asked to commence the medication 3 days prior to the brachytherapy and will continue it for approximately 8 weeks after the brachytherapy. You take one tablet a day - at night before you go to bed.

It can have potential side effects, the most common of which is dizziness. If this occurs, cease the medication and contact Dr Swindle. After 8 weeks you should stop taking the medication each day and take it every second day for 2 weeks. If you have no problems with passing your urine at the end of the 2 weeks then cease the medication. If you have trouble passing your urine when you are taking the tablet every second day, increase it back to one tablet a day and contact Dr Swindle.

Noroxin:

This is an antibiotic and is started in hospital on the evening of the procedure and continued for 3 days after the procedure. It is taken twice a day either 1 hour before or 2 hours after food. Allergic reactions to medications sometimes occur and can cause a rash or unusual reaction. If this occurs stop taking the antibiotic and contact Dr Swindle for advice.

Pain Relief:

The procedure does not cause a great deal of pain and usually all that is required is panadol. Occasionally stronger pain relief such as Panadeine may be required.

You may resume a normal diet and activity the day after the procedure. You should however avoid heavy lifting or straining for 4 weeks. The following is a list of some potential issues that you need to be aware of:

Red urine:

It is common to have small amounts of blood in your urine for a few days following low dose rate brachytherapy. Water is the best fluid to assist flush any blood from your urine. You should not have any blood clots in your urine so if you are passing blood clots please contact Dr Swindle.

Frequent urination:

Urinary frequency and burning are common after low dose rate brachytherapy. These symptoms may continue for several weeks to a few months after the procedure and are most troublesome from 1-3 months after the implant. Nearly all patients have these symptoms and they resolve in 90% of patients. 10% of patients can have ongoing symptoms for up to a year and 1% of men can have permanent symptoms.

These symptoms can be helped by an alpha blocker such as Flomaxtra or Xatral and occasionally an anti inflammatory medication may be prescribed. Very rarely if patients have terrible symptoms, a catheter may be required but this is extremely uncommon.

Bruising:

It is common to have bruising and swelling of the testicles and perineal area lasting about 3–4 weeks after low dose rate brachytherapy. Applying an ice pack can help decrease discomfort, but this requires no treatment.

Bowels:

Some patients suffer from constipations following low dose rate brachytherapy. All that is usually required is an increase in fibre, fresh fruit and vegetables however occasionally a stool softener may be required. Occasionally patients complain of bowel irritation such as diarrhoea or frequency however this rarely requires specific medical treatment. This can usually be dealt with by reducing the roughage in the diet by minimising fruit and fibre intake.

Sexual activity:

It is recommended that sexual intercourse can be resumed 1 month after the brachytherapy. Although it is quite safe for you and your partner to resume normal sexual activity following an implant, it is recommended to initially use a condom for 2-3 weeks after resuming sexual activity as there is a small risk that a seed may be passed in the semen within the first couple of ejaculates.

It is also common for the semen to be discoloured dark brown or black as a result of bleeding into the prostate or the seminal vesicles, as a result of the implant. This discoloration should resolve within a few months.