Seed Radiation

Candidates: Men of any age but with a Gleason score 6 or less and a PSA less than 10. Minor surgery required, so may not be appropriate for some men with severe medical conditions. Not suggested for very large prostates unless initially shrunk by hormone therapy, nor for men with chronic bowel disease. Not appropriate for men who have had surgery for BPH.

Chance of cure: Appears favorable so far, but long-term data are not yet available.

Convenience: Very convenient, usually requiring only outpatient surgery with rapid recovery. No restriction of activities except for the first few days.

Sexual side effects: Initially minimal, but impotence slowly increases over several years to 40 to 60 percent. Has the unsupported reputation of causing less sexual dysfunction than beam therapy. Painful orgasm and blood in ejaculate have been reported. Rate of impotence much higher if beam therapy or hormone therapy is used with seed therapy.

Urinary side effects: Incontinence rate lower than surgery but still 5 to 10 percent. Irritative urinary symptoms may be severe and persistent, more so than for beam therapy.

Bowel side effects: Frequency, urgency, cramping, and bleeding occur in 10 to 20 percent of patients and may be persistent.

Other side effects: Men are mildly radioactive for up to two months.

Follow-up treatment if needed: Surgical treatment difficult because radiation distorts anatomical landmarks and causes scarring of tissue; other options open.

Uncertainties: Provides little information on extent of cancer and possible spread. Posttreatment PSA is unclear as a predictor of recurrence, especially with PSA bounce.

Unknowns: Chances of residual prostate cancer in remaining prostate cells; likelihood of another form of cancer secondary to radi ation effects; chances that the cancer has already spread beyond the prostate.

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