The procedure

The prostate brachytherapy procedure
The prostate brachytherapy procedure is when the radioactive seeds are implanted into your prostate gland under a general anaesthetic, in our operating theatre.

Your appointment for your prostate brachytherapy procedure is normally about 3 weeks after your last ultrasound scan.

You will be admitted to hospital for the day or over night.

The procedure takes about 40 minutes. Afterwards you will spend about an hour in the recovery room recovering from the effects of the anaesthetic before returning to the ward. You will then be discharged from the hospital (either later that day or the following morning).

The procedure

The day before the seeds are implanted
You will need to take a bowel preparation to empty your bowels. If your bowels are not empty the ultrasound scan pictures of the prostate during the procedure may not be clear.

You will be sent a sachet of a powdered bowel preparation called Picolax. After mixing the contents of the sachet with water, drink the bowel preparation on the day before you come to the Centre for the prostate brachytherapy procedure. It is important that you drink plenty of water both the day before and for at least 48 hours after the procedure to make sure you keep yourself hydrated.

The procedure

On the day you have the seeds implanted
Our anaesthetist will give you a general anaesthetic so you will not feel any pain or discomfort. When you are asleep, an ultrasound probe will be placed into your rectum (back passage) and a catheter (a tube for passing urine) will be inserted into your bladder through your urethra (the water pipe).

The ultrasound probe is removed before you wake up and the catheter is removed once the effects of the anaesthetic have worn off and you have had a CT scan to confirm the position of the seeds.

Under a general anaesthetic
The ultrasound probe allows us to see a picture of your prostate gland.

Our planning computer will construct a three-dimensional (3-D) picture of your prostate gland so that we can calculate where we need to implant the seeds.

We will insert between 20 and 30 fine hollow needles into your prostate gland through the perineum (the skin between the scrotum and the anus). The ultrasound pictures help to guide the needles to the exact planned position.

CT scan of seeds in place

The procedure

We will insert between 2 and 6 seeds through each of the needles and implant between 60 and 120 seeds in total into your prostate gland. We will implant some of the seeds around the edge of your prostate gland. These seeds are woven into a strand of absorbable material that helps keep the seeds in place.

We will implant the rest of the seeds into the centre of the prostate gland individually so that we can make sure that we tailor the position of the seeds to the shape of your prostate. The ultrasound probe takes pictures continuously throughout the procedure to check and verify the position of the needles and the seeds.

Once all the seeds have been inserted via the needles and are in the right place The needles are removed and the seeds remain permanently in place. You will have a CT scan to confirm the position of the seeds.

The procedure

After the seeds are implanted
Drink plenty of water

For one week after the implant, you must drink plenty of water to flush through any small blood clots that may occur in the urine. Thereafter, you should return to a normal drinking pattern and your daily intake should not normally exceed 1.5 litres per day (about 2½ pints). It is important that you avoid all caffeinated drinks (tea, coffee, coke) in the first few months after the implant, as these are likely to aggravate your urinary symptoms.

Many of our patients find Red Bush or Rooibos tea pleasant caffeine-free alternatives to drink. Alcohol, in moderation, is fine.

You may also find that cranberry juice is helpful. One glass per day is enough.

The procedure

Take any medicines we give you
After your brachytherapy treatment we will give you some medicines to take: These are an alpha-blocker, such as tamsulosin (Flomax®) or alfuzosin (Xatral®). This medicine relaxes the muscle within the prostate gland and helps to reduce the narrowing of the urethra (water pipe) as it runs through the swollen prostate, so reducing urinary symptoms. This is best taken in the early evening. You will be encouraged to take this medicine for at least 3-6 months after the implant. Your GP will give you a prescription for these when you run out.

An anti-inflammatory painkiller, such as diclofenac sodium (Voltarol®).This medicine has two benefits. It is an effective painkiller and will reduce inflammation in the swollen prostate gland, so helping to relieve urinary symptoms. You will receive a one-week supply of this tablet from the hospital. Some patients find that they may require a longer course of this medication and this can usually be obtained from your GP.

A course of antibiotics, usually ciprofloxacin, to be taken for one week after the treatment. You will receive a one-week course of antibiotics. These will help to prevent infection following the implant. They are safe to take with an alcoholic drink if desired.

The procedure

Take any medicines we give you
A short course of a laxative, Senna® in case you experience any constipation during the first week after treatment.

After you have had the radioactive seeds implanted we will want to check on how you are and how successful your treatment has been.

After prostate brachytherapy we will want to see you at the Centre

• within 2-4 weeks

and again at

• about 3-4 months
• 6 months
• 9 months
• 12 months
• then 6 monthly for a further 4 yearsas research studies have shown this can increase your chances of a success.

The procedure

At your follow-up appointments, 3 months after your prostate brachytherapy and from then on we will ask you to have a blood test to measure your levels of prostate specific antigen (PSA). Your PSA level gives an indication of your treatment success. The average PSA level of our patients 4 years after implant is 0.2ng/mL.

Approximately 25% of patients will experience a temporary small rise in PSA (a 'PSA bounce'), typically anytime between 6 months to 2 years after the procedure. The amount your PSA may rise or bounce is usually less than 4ng/mL. This is quite common, and the PSA will start dropping again after a few months. The reasons for this bounce phenomenon are unclear, but it does not have any effect on the overall success of the treatment.

Even though your treatment has been successful there will always be a very low level of PSA present while you still have your prostate gland. However, the level may be so low that it does not show up on your test results.