Radioactive Seed Implant
Post-operative Side Effects Management
The side effects after prostate brachytherapy typically come in two phases. The first phase occurs right after the procedure, as a result of prostate swelling and bleeding from prostate needle trauma, resulting from the needles that were used to introduce the seeds into the prostate. There is usually an intermittent passage of blood in the urine and ejaculate during this time, because invariably, the needles also traumatize the bladder, seminal vesicles and urethra to some degree. Too, an impressively black and blue area usually forms behind and around the scrotum that resolves over the following 2-3 weeks. There may also be post-procedural pain in the pelvis and penis, but this is usually mild to moderate and easily controlled with prescription pain medicines. Rectal-anal irritation may also occur but usually this is a minor and transient condition, resulting from the pre-brachytherapy bowel preparation and the presence of the ultrasound probe in the rectum to guide the procedure. It typically resolves in about a week. Rare patients with preexisting hemorrhoids have had more severe, though still temporary, rectal-anal symptoms after the brachytherapy procedure.
In about 10% of our patient population we see full-blown urinary obstruction after the procedure, where a patient is unable to urinate at all, requiring the placement of a urinary catheter for some period of time. This condition usually persists for only a few days but rarely, for long periods of time.
The first-phase side effects normally resolve within a week or two and the 5 medications discussed in Section 3 - “Admitting examination and labs” are normally sufficient to control the phase one side effects until they subside.
The second phase of side effects results from the radiation emitted from the seeds, and builds weeks to months after the brachytherapy procedure, typically lasting for 3-9 months after that. Again, urinary side effects are the predominant condition. One of the medicines routinely prescribed before the procedure, Flomax, is continued for many months after the procedure, until the urinary tract finally stabilizes.
Sometimes, depending on the circumstance, additional medicines may be prescribed. A brief synopsis follows:
Other medicines that we may recommend or prescribe for brachytherapy patients:
High-dose Prednisone (Steroid anti-inflammatory) – We often use this medicine within the first few months after the brachytherapy procedure, in patients who have worsening urinary obstruction problems. The higher the dose and the longer the duration of this medication, the more problematic become the side effects. On the other hand, it is a powerful swelling reducer and often creates a very good urinary flow improvement in our patients, when other medicines do not. We balance these factors to the best of our ability for our patients. In general, Prednisone is a short-term rather than a long-term solution to prostate swelling after the procedure.
Non-steroidal anti-inflammatory medicines: Examples include Advil, Motrin, Aleve, Celebrex, Naprosyn, Vioxx, Relafen and others – These medicines tend to help with prostate swelling and discomfort and unlike Prednisone or other steroid medications, with proper medical supervision, may be used indefinitely if needed.
Ditropan, Detrol: Occasionally used for bladder spasms or urgency
Viagra: For erectile dysfunction
Anusol HC, Metamucil: For lower bowel-anal problems that occur in rare brachytherapy patients
Antibiotics: If indicated for infection
Our nurses and doctors work together to help the patient gain control over his symptoms, until the brachytherapy side effects resolve. In patients with more challenging or severe urinary side effects, we may also ask for help in their management from the referring urologist. The typical brachytherapy reaction takes 3-9 months to resolve, sometimes extending as long as 12 months or more. With proper medication and attention though, the side effects are typically manageable, the patient’s normal lifestyle is usually maintained, and the long-term outcome is good.
