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Prostate Implants
Diet:
Regular, unless you are on a special diet for other reasons
Activity:
Avoid heavy lifting or strenuous physical activity for the first two days, once you are home. After that, you may return to your normal activity level.
Possible Side Effects:
There are very few side effects from the implant procedure. However, minor burning on urination, urinating more frequently, mild pain or feeling unable to pass urine freely are common and usually stop in one to four months.
You are likely to see blood in your urine after the implant for the first twenty-four hours. If, after 24-48 hours, visible blood persists or if you begin to pass clots, you should contact your urologist.
Antibiotics are given after the implant to prevent infection. You should take the antibiotic as prescribed by your physician until the medication runs out. If you develop an allergic reaction, such as a skin rash, stop the medication and contact your physician.
Radiation Safety:
Radiation safety is a concern of many of our patients. I-125 and Pd-103 are low energy radioactive materials and lose their activity quickly. The low energy of the seeds mean that their radiation is contained within the prostate gland, for the most part. However, some amount of the radiation is given off to structures very close to the prostate, such as the rectum. The precautions listed below, that we ask you to observe, are to ensure that those around you are protected from unnecessary radiation. Objects that you touch or items that you use are NOT radioactive.
Precautions:
Any pregnant, or possibly pregnant, woman should avoid prolonged close contact with you for the first two months after the implant. She should not hug you or sit very close to you. She can greet you briefly and then move to a distance of 6 feet or more away. At a six foot distance, there is no limit to the length of time she can be in the same room.
Children should not be allowed to sit on your lap during the first two months following the implant.
Sexual intercourse with a condom may be resumed two weeks after the implant. Your sperm may be discolored dark brown to black. This is normal and is a result of bleeding that may have occurred during the implant and is now being released into the ejaculate. After two months, it will not be necessary to use a condom.
After removal of the urinary catheter, and for up to one week after the implant, it is possible that you could lose seeds through urination or in the ejaculate following sexual intercourse. Because of this possibility, we ask you to strain your urine for the first week following the procedure. If you notice a seed and can retrieve it, please do so using a tweezers and place the seed into the packet provided. Return the seed to the St. John's Radiation Therapy Dept. at your convenience (phone # 569-6844).
Possible Side Effects From The Prostate Implant
Immediate Post-Op Side Effects:
- Slight bleeding beneath the scrotum
- Blood in the urine
- Bruising and tenderness between the legs
These side effects are caused by the needles used to place the seeds. Usually twenty to twenty-five needles are used. The seeds themselves, the urine catheter and other instruments used during the procedure, also can contribute to these side effects. If you should experience severe pain or severe bleeding, you should call your urologist.
A catheter is placed into your bladder during the surgery and is removed several hours later. In some instances, it is left in overnight. It is normal to have some blood in the urine which will drain from the catheter. This bleeding may continue for several days, so do not be alarmed. If it becomes severe and/or is associated with large clots, call your urologist. Drinking plenty of water helps prevent blood clots and flushes the bladder.
After the catheter is removed, it is normal to experience some burning with urination. If you cannot urinate within six hours after removal of the catheter, you need to contact your urologist or go to the Emergency Room for care especially if you have a feeling of bladder discomfort/fullness.
Later Side Effects:
- Frequent urination
- Burning with urination
- Sense of urgency
- Weaker urinary stream
After healing from the implant, most of the side effects are due to the radiation in the seeds that were placed into the prostate. The radiation causes swelling and irritation of the prostate which causes the above symptoms. Drinking plenty of fluids and avoiding caffeine-containing beverages may help to relieve these symptoms. If they are bothersome, medication from your radiation oncologist or urologist may be helpful.
Follow-Up:
Within several days of the implant, you will be asked to return to Radiation Oncology/Urologist for a brief visit and a CT scan. The CT scan will enable the physicians to determine the exact position of each seed in the prostate. This is necessary in order to determine that your prostate gland is receiving the proper amount of radiation throughout the entire gland. On rare occasion, it has been necessary to give an additional amount of radiation with either external beam or another implant.
Follow-up with your urologist and radiation oncologist will be done on a regular basis. A sample follow-up schedule will be given to you at the time of your implant, but plan on a visit approximately every three to six months for the first five years. Physical examination, blood tests and rectal ultrasound tests will be done at certain intervals as part of your follow-up visits.
Medication Information
The following medications and recommendations can improve or lessen your symptoms.
Medications:
Bactrim DS (often labeled as Sulfa) This is an antibiotic. Please take this in the evening after your implant and then two times a day until it is gone (approximately 8 days). Occasionally, people may have allergic reactions to this medication. If you develop a rash or unusual reaction, please call for advice.
Cipro 500 mg This is an antibiotic. Please take this in the evening after your implant and then two times a day until it is gone (approximately 8 days). Occasionally, people may have allergic reactions to this medication. If you develop a rash or unusual reaction, please call for advice.
Levaquin 500 mg This is an antibiotic. Please take this once a day until it is gone (approximately 8 days). Occasionally, people may have allergic reactions to this medication. If you develop a rash or unusual reaction, please call for advice.
Aleve 200 mg This is an anti-inflammatory drug usually given for arthritis symptoms or pain. After the implant, it is given to help reduce the swelling associated with the implant and improve urination. Aleve is an over the counter drug, so you can buy it off the shelf at the pharmacy. Normal dose is two tablets every twelve hours with food. Take this for one week and then follow your doctors advice regarding how to taper it. Many people find that they can decrease the dose after about one week. If you feel it is not helping, you may discontinue it. It is a good idea not to run out of this medication. You can change the dose to suit your needs. NOTE: This medication can worsen ulcer symptoms. If your stomach is irritated or you have black stools after taking this medication, stop it and inform your doctor.
Ibuprofen 200 mg (Advil, Motrin) This is an anti-inflammatory drug usually given for arthritis symptoms or pain. After the implant, it is given to help reduce the swelling associated with the implant and improve urination. Ibuprofen is an over the counter drug, so you can buy it off the shelf at the pharmacy. Normal dose is 3 tablets (600 mg) every eight hours with food. Take this for one week and then follow your doctors advice regarding how to taper it. Many people find that they can decrease the dose after about one week. If you feel it is not helping, you may discontinue it. It is a good idea not to run out of this medication. You can change the dose to suit your needs. NOTE: This medication can worsen ulcer symptoms. If your stomach is irritated or you have black stools after taking this medication, stop it and inform your doctor.
Cardura 4 mg This medication relaxes the muscles of the urethra and bladder allowing for improved stream and complete emptying of the bladder. Typically, the starting dose is 2 mg (1/2 pill) at bedtime for the first 2 nights, then one 4 mg pill at night. Take this for at least two weeks and then follow your doctors advice regarding how to taper it. It is a good idea not to run out of this medication.
If you stop this medication and wish to begin again, start with 2 mg (1/2 pill) for the first two nights. This medication is used for blood pressure. It can interact with other blood pressure medications. A possible side effect is the lowering of the blood pressure causing some light headedness or dizziness. If lightheadedness or dizziness occur, either sit or lie down immediately until the sensation goes away. The dose may need to be lowered or the medication stopped. Discuss this with your doctor.
Hytrin 1-2 mg This medication relaxes the muscles of the urethra and bladder allowing for improved stream and complete emptying of the bladder. Typically, the starting dose is 1 mg initially, then another 1 mg at bedtime the first day. Thereafter, 2 mg in the a.m. and 2 mg at night is effective. Higher doses may be required. Discuss this with your doctor. The dose can be adjusted to suit your needs. It is a good idea not to run out of this medication.
This medication is used for blood pressure. It can interact with other blood pressure medications. A possible side effect is the lowering of the blood pressure causing some light headedness or dizziness. If lightheadedness or dizziness occur, either sit or lie down immediately until the sensation goes away. The dose may need to be lowered or the medication stopped. Discuss this with your doctor.
Flomax 0.4 mg This medication relaxes the muscles of the prostatic urethra allowing for improved stream and complete emptying of the bladder. Typically, the starting dose is 0.4 mg at bedtime. This is not a high blood pressure pill and should have little effect on your blood pressure. However, if lightheadedness or dizziness occur, either sit or lie down immediately until the sensation goes away. Discuss this with your doctor. It is a good idea not to run out of this medication.
Pyridium 200 mg This medication is used to relieve pain, burning and discomfort of urinary tract infections or irritations. Take this pill 3 times daily with food or after meals to prevent stomach upset. This medication will cause your urine to turn orange-red in color. This is not harmful and will disappear when the medication is stopped. Notify your doctor if the following symptoms persist or become severe: stomach upset, headache, dizziness. If you develop a skin rash or experience weakness notify your doctor right away. Do not wear your contact lenses while taking this medication as it may cause staining.
Tylenol with Codeine // Vicodin // Demerol // Darvocet // Percocet These are narcotic pain medications. Use as directed. Note that narcotic pain medications may cause constipation, and you may wish to take a stool softener. These may be taken with Aleve.
Tylenol Extra Strength Take as directed for pain. These may be taken with Aleve or ibuprofen.
