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Ask The Expert Archive

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Prostate Brachytherapy Archive Questions

Below are Dr. Kwok’s answers to Prostate Brachytherapy questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 8 of 8.


Q : 1

What are current rates of impotence for a man in his 50s after brachytherapy?

This is extremely difficult to answer and quite controversial given the fact that as men age, many factors add to the dysfunction. Common factors include high blood pressure and the medication, diabetes, and high cholesterol. I think it is conservative to say that 75 percent of men will retain function after brachytherapy in the absence of other factors known to cause impotence.

Q : 2

I am 45 years old and was recently diagnosed with PC. I do not have an enlarged prostate, or other urinary symptoms. I'd prefer brachytherapy to surgery. Could I be a candidate?

I like prostate brachytherapy in general. What you have to realize is that many radiation oncologists including myself don't like to do brachytherapy in 45-year-old patients since we do not have great experience beyond 20-25 years in such young patients. The only paper published that I know of is a paper in 2008 by Merrick looking at 42 patients younger than 50 years. However, the average follow up was only 5 years. Late urinary symptoms can occur 10-20 years after radiation. So, while I can say you will do well in the short term, I cannot tell you how you will be 20 years from now. If you are comfortable with this, I think you should go for brachytherapy. But if there is any hesitation, you should think about surgery with the urologist.

Q : 3

My husband just had this procedure. Is it OK for me to sleep next to him and for him to hold our 7 lb dog in his lap?

This is not dangerous for you or the dog.

Q : 4

My Dad had seeds implanted in 1999 and is now dealing with some prostate issues. Can the prostate be removed after the seeds have been implanted?

We do not typically remove the prostate (prostatectomy) given the risk of potential injury to the bladder and rectum. We do sometimes do a TURP after implant where only part of the prostate (middle) is removed. I would consult a urologist who has experience in this matter.

Q : 5

What do the seeds used in low-dose brachytherapy look like? I have been told to strain my urine to see if one of the seeds has escaped down the urethra. What size are they?

You can google "prostate seeds" and click on "images" at top and thousands of pictures will come up.

Q : 6

I'm 44 and had a PSA of 15 twice and 11 once. I chose to have the robotic surgery and my Gleason score was 7. Was I a candidate for seeding?

Yes. There are now multiple papers demonstrating that seeding is very effective and safe in patients age less than 50 or less than 60. The opinion that surgery is the only option for young patients is an old, archaic idea.

Q : 7

I was just diagnosed with prostate cancer. I am 56 years old. My urologist told me that the cancer was in a very early stage. He recommended seed implantation and alternatively, removal of the prostate as my 2 options. I want to preserve my sexual function. I believe seeds is my best option, but how do I know that it would give me my best chance for survival? Is the survival rate comparable to that of the other option, which I don't prefer?

Its hard to know for sure without knowing your T-stage, Gleason Score and PSA. Let's just assume that your T-stage is T1c or T2a (small or no nodule), Gleason score of 3+3=6 and your PSA<10. Then you would classically have low-risk prostate cancer (and maybe even very low risk), and your cure rate (95% or higher) is the same whether you get seeds, surgery or external radiation (with IMRT).The choice then becomes a personal one. The worst side-effect profile would be radical prostatectomy (even robotically). I like seeds for many reasons, but both of the radiation choices (seeds or IMRT) are excellent.

Q : 8

How safe is it to be around someone with the prostate seeds? How long are they radioactive? What precautions must other family members take?

How long a person is radioactive for depends on what kind of seeds/sources he received. Half-life (how long it takes 50% of the source to decay) of the commonly used isotopes are as follows: Iodine-125 = 60days, Palladium-103 = 17days, and Cesium-131 = 9.7days. For the longest half-life with I-125, we say kids and pregnant women should be careful (sitting on laps or sitting a long period of time next to the patient) for the first couple of months. For C-131 and Pd-103, we say there are no concerns after the 1st month. Otherwise, there are no concerns with spouses and family members who are not kids or pregnant since the radiation exposure is minimal.


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