Compared to other treatments for prostate cancer, seed therapy is convenient—a major reason for its increasing popularity. Usually, only two outpatient visits are required.
On the first visit, the radiation oncologist places an ultrasound probe, similar to that used in prostate biopsies, in the rectum and then carefully maps the prostate. This allows for a calculation of exactly where seeds should be placed and how many—usually fifty to one hundred—will be needed.
On the second visit, the man is given a regional block (spinal or epidural) or general anesthesia for a procedure that lasts approximately an hour. While he is on his back with his legs elevated and spread, long needles are inserted into the prostate through the perineum, the area between the back of the scrotum and the anus. The radioactive seeds, which are smaller than grains of rice, are inserted into the prostate through the needles. It is vital that the seeds be placed evenly, so that no areas of cancer are left untreated; therefore, ultrasound, CT scans, and/or fluoroscopy are used to guide the placement. An antibiotic is given to minimize the chances of infection.
Following the procedure, the patient is taken to the recovery room for a few hours, then allowed to go home. A urinary catheter is
John Blasko, M.D., is a pioneer radiation oncologist in Seattle and a leader in promoting seed therapy. He advises men to take a week off from work following the implantation procedure. He is also quoted as saying: ''The only people I send back to work right away are lawyers. These people are used to being a pain in the ass.''
—Michael Dorso, Seeds of Hope used during the procedure but is usually removed before discharge. Postoperative pain can be controlled by ice packs and pain pills. A graphic first-person account of this procedure is found in Michael Dorso's Seeds of Hope.
Following implantation of the seeds, the patient can resume normal activities within days. One man claimed to have run a halfmarathon two weeks after the procedure!1 Most men have some continuing discomfort, including frequency and urgency of urination, abdominal tenderness, and pain in the rectum. These symptoms generally resolve over several weeks, although they may recur later.
After implantation of the seeds, men are mildly radioactive for up to two months. During that time, they are advised not to stand within six feet of a pregnant woman, not to allow small children to sit on their laps, and not to try to conceive a child. Some physicians also ask them to wear a condom during intercourse in case a radioactive seed is expelled with the ejaculate. Modern screening techniques at airports may also detect radiation from the seeds, so men may wish to carry a note from their physician. By the end of the two months, the seeds are no longer radioactive and remain in the man's prostate for the rest of his life.
The follow-up for men with seed therapy generally consists of an appointment two to three weeks after implantation to assess the dose of radiation. Another appointment a month later assesses
Recovery from Seed Therapy
As I was dressing, I realized that my scrotum was twice its normal size, and deep purple! That startled me. I had an ache in my groin, but my scrotum looked like I should be feeling serious pain!
That evening wasn't too bad. My job was to lie in the hotel bed with an ice bag in my crotch. Pain pills made it tolerable as I watched TV. I had a constant urge to urinate, and was up frequently trying to pee, but with limited success. Sometime in the middle of the night I passed an obstructing blood clot through my penis—followed by a surge of pent up urine. Now that got my attention! That was probably the most uncomfortable event of the entire therapy.
—Michael Dorso, Seeds of Hope
Here in this surrealistic chamber was the best that modern medicine had to offer. It would be here that I must fight my battle with the killer in my groin. . . .
There I was, alone in this temple of technology. Everyone else had fled the radiation that would soon be flooding the room. A mental image of a sacrificial lamb on the altar flashed through my mind. . . .
Even though I knew I would feel nothing when the radiation hit me, I had to resist the urge to cringe. I felt a need to lighten up, as I lay there staring up at the x-ray machine. I chose to address the one-eyed Cyclops. ''Take me to your leader, alien!'' It must have heard me! Suddenly it was alive and buzzing.
—Michael Dorso, Seeds of Hope possible complications. A PSA and rectal exam are usually done every four to six months for the next five years, then annually.
The procedure for beam therapy is substantially more onerous than for seed therapy, despite the fact that beam therapy involves no anesthesia, surgery, or pain and is performed completely on an outpatient basis.
Before beam therapy can be started, several visits to the hospital's radiology department are required. During these visits, a cradle-like cast is made of the man's body; during each radiation treatment, he will lie in that cast to ensure that he is absolutely immobile and unable to move during the treatments. Small black tattoos are placed on the lower abdomen so that the radiation beam can be correctly aligned each time. The lower abdomen is carefully mapped by putting a contrast material into the bladder and rectum and taking X-ray pictures of it; this helps ensure that the radiation beam will be directed precisely at the prostate and not at another organ.
The actual treatments are given five days a week for five to nine weeks. Thus, men must be prepared to follow a rigid treatment schedule for several weeks and are not allowed to miss a treatment. This regimen may pose no problem for men who work in metropolitan areas where they can stop by the hospital each day on the way to work. But for men who live in more rural areas, it may involve staying in a hotel in the city for the entire treatment period.
The treatments themselves are quick and painless. The man lies in his custom-made cast on the X-ray table in a semidarkened room for about fifteen minutes. Depending on the specific type of beam therapy being used, the huge X-ray machine may be stationary overhead or it may move during the treatment. Laser beams, often from several directions, give the room a Star Wars ambience; one half expects to see Han Solo and Luke Skywalker come through the door.
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