What does the procedure involve?
Insertion of radioactive seeds into the prostate gland through needles placed through the skin behind the scrotum (perineum); it may also require telescopic examination of the bladder.
What are the alternatives to this procedure?
Alternatives to this procedure are active surveillance, external beam radiotherapy, radical prostatectomy, laparoscopic prostatectomy, robotic prostatectomy and hormone therapy.
What should I expect before the procedure?
You will be asked not to eat and drink for six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for warfarin, aspirin or clopidogrel (Plavix®).
- A previous or current MRSA infection.
What happens during the procedure?
A full general anaesthetic is normally used and you will be asleep throughout the procedure. You will usually be given an injection of antibiotics before the procedure, after you have been checked for any allergies. The anaesthetist may also use an epidural or spinal anaesthetic to reduce the level of pain afterwards.
The procedure takes approximately 2½ hours. A catheter is inserted into the bladder via the water pipe (urethra) and remains in place until the next morning. An ultrasound probe (pictured) is then passed in the rectum and 15 – 30 needles are directed into the prostate through the skin between the anus and the scrotum (the perineum). 60 – 90 radioactive seeds are inserted through the needles into the prostate gland.
What happens immediately after the procedure?
A compression dressing is placed between your legs, to reduce the swelling caused by penetration of the needle. The bladder catheter is removed the day after insertion of the seeds. The average hospital stay is two days.
Are there any side-effects or complications?
Most procedures have possible side-effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.
Common (greater than 1 in 10)
- Temporary insertion of a bladder catheter.
- Bruising and discolouration of the perineal skin.
- Difficulty passing urine (10 - 15%).
- Frequency passage of urine with urgency.
- Need to self-catheterise temporarily whilst the swelling of the prostate settles.
- Bloodstained urine for several days.
- Impotence due to unavoidable nerve damage from the seeds (20 - 40%).
Occasional (between 1 in 10 and 1 in 50)
- Development of urethral stricture requiring surgery.
- If the tumour does not respond completely, other treatment including surgery and/or hormonal treatment.
- Rectal discomfort with discharge of blood or mucus from the anus.
- Infection of the bladder requiring antibiotics.
- Bleeding and swelling of the prostate preventing urination.
- Urinary incontinence (temporary or permanent).
- Passage of the radioactive seeds in the urine due to migration out of the prostate.
- Occasional need for surgery to the prostate if there is persistent difficulty in passing urine.
Rare (less than 1 in 50)
- Rectal damage requiring temporary colostomy.
What should I expect when I get home?
You will be discharged with mild painkillers and a 7-day course of antibiotics. Tablets to ease the flow of urine (alpha-blockers) will also be prescribed and may need to be continued for a period of 3 - 6 months.
What else should I look out for?
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your Surgeon or GP immediately.
Are there any other important points?
Children and women who are or, may be, pregnant should not sit close to you or on your lap for 3 months after seed implantation.
During the first few weeks after seed implantation, condoms should be used during sexual intercourse. These should be disposed of in a dustbin, double-wrapped in aluminium foil. Seeds may, occasionally, pass in your urine. If this happens in the toilet, try to retrieve it with a spoon or a pair of tweezers, and dispose of it as above.
For specific advice relating to seed implantation, please contact surgeon or radiation oncologist.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.