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    Brachytherapy - Patient Handbook

    Patient Referral and Insurance Coverage

    A referral is required from a primary care provider or physician specialist. Prostate brachytherapy is a treatment option covered by Medicare, Medi-Cal and most private insurance companies. Persons interested in brachytherapy should contact their insurance company prior to treatment to confirm coverage and obtain authorization for prostate brachytherapy services.

    What is a Volume Study?

    A volume study is an important initial step in the preparation for your prostate seed implantation. It provides the picture measurements of your prostate for the Dosimetry Plan, a calculation of the number of seeds and their precise placement, in order to deliver the prescribed dosage of radiation to your prostate.

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    The Seed Implantation

    Using the electronic images from the volume study, the dosimetry computer software automatically calculates the volume of the prostate in cubic centimeters. A radiation physicist and dosimetrists, aided by sophisticated computers, use the volume study to determine the number of seeds required and the exact placement of the seeds.

    Although the implant procedure does not require a surgical incision it is performed in the operating room and takes one to two hours. A small ultrasound probe is inserted into your rectum to visualize your prostate gland on a monitor. Needles are then passed through the skin between the rectum and the scrotum, guided into the correct position using the ultrasound probe. Once in place, the seeds are inserted through the needles into the prostate.
    Preparations for Seed Implantation

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    After the Implant

    Approximately one month after the implant, a follow-up pelvic X-ray, chest X-ray, and CT scan are completed. These images assist the radiation physics staff to calculate the actual radiation dose received to your prostate gland. The chest X-ray is taken to rule out blood stream seed deposits in the lungs.

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    Radiation Safety

    Radiation safety is a concern for everyone involved in prostate brachytherapy. The radioisotopes 125Iodine and 103Palladium are low energy radioactive materials and lose their activity quickly. Most of the radiation is contained within the prostate gland. Some amount of radiation is given off to structures very close to the prostate and a very small amount is present outside the body. Objects that are touched or used are not radioactive, nor are bodily wastes.

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    Special Precautions

    Precautions should be taken when in contact with small children and pregnant women. The risk to pets from sitting on a patient's lap is extremely low. These precautions will ensure that everyone is protected from unnecessary radiation.

    Any pregnant or possibly pregnant woman should avoid prolonged personal contact with a bracyhtherapy patient for the first two months after treatment. She should not hug you or sit next the patient. She can greet and then move to a distance of six feet or more away. At the six-foot distance, there is no limit to the time she can be in the same room.

    Children should not be allowed to sit on a patients lap during the first two months following the implant. They can sit next to a patient for any length of time.

    Sexual intercourse with a condom may be resumed immediately after the implant. Initial ejaculations may be uncomfortable and discolored. This is a normal result of bleeding that may occur during ejaculation or which occurred during the implant procedure. After two weeks, it is not necessary to use a condom. It is extremely rare for a seed to be released into the ejaculate.

    Occasionally, seeds remain in the bladder after the implant and are passed into the urine. This will usually occur within one day after the implant.

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    Procedure Side-effects

    There are very few short-term side effects from the implant procedure. Patients may experience minor burning during urination, more frequent urination, or feel unable to pass urine freely and may pass small amounts of blood or clots. These temporary symptoms are common and usually stop in a few days or a few months. In most situations side effects are moderate. It is also common to have some bruising in the area of the implant or feel fullness when sitting.

    NOTE: On rare occasions, complete blockage of urination may occur. If this happens, see a physician or go to the hospital Emergency room to have a catheter placed in the bladder.

    Risks for impotence, incontinence, and rectal injury exist with all forms of prostate cancer treatment and are the primary concerns of men and their families.

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    A regular diet is recommended unless on a special diet for other health related reasons. Some foods and liquids can be slightly irritating to the bladder, causing increased frequency of urination, discomfort and slower urine stream. Generally it is not necessary to eliminate these foods from the diet, but decrease the amount.
    Foods that may cause bladder irritation

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    Physical Activity

    Avoid heavy lifting or strenuous physical activity for the first few days. After that patients may return to your normal activity level. Occasionally, vigorous activity may cause some minor blood in the urine.

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    It is important to have regular follow-up examinations to monitor the prostate cancer treatment. Digital rectal exams and PSA blood test will be done at regular intervals. If you are out of the area, we ask that your local physician send us your test results.

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    Kegel Exercises

    Kegel exercises are pelvic floor muscle exercises designed to improve bladder control and incontinence. These muscles contract and relax under your command to control the opening and closing of your bladder. When your pelvic muscles are weak urine leakage may occur. Through regular kegel exercise you can build up pelvic floor muscle strength and, in many cases, regain bladder control.

    Begin by locating the muscles to be exercised. As you begin to urinate try, to stop or slow the urine without tensing the muscles of your legs, buttocks or abdomen. It is very important not to use these other muscles as only the pelvic floor muscles control the bladder. When you are able to slow or stop the stream of urine, you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.
    Performing kegel exercises

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