The first step in the brachytherapy procedure is the use of ultrasound to determine the position and the shape of the prostate. The ultrasound procedure typically takes from twenty to thirty minutes to carry out. Once the size of the patients prostate is figured out the doctor is able to calculate how many radioactive seeds are required to be inserted into the prostate for the brachytherapy. This is typical in the region of fifty to a hundred. The ultrasound also enables the doctor to reconstruct the spatial spread of the cancer within the prostate.
One of the advantages of brachytherapy is that it can be performed as an outpatient treatment. In order to for the doctor to better visualise the prostate the patient should follow a strict clear liquid diet the day before the brachytherapy treatment for prostate cancer, and they should refrain from any intake of food at midnight on that day.
The Brachytherapy Process
The use of a fluoroscope and ultrasound is used by the doctors in the operating room to visualise the prostate. The next step of the brachytherapy process is to insert and guide needles, approximately eight inches in length, which contain the radioactive seeds into the prostate (this is for low dose rate permanent prostate brachytherapy, for temporary high dose treatment catheters replace the needles to enable repeated insertion of radioactive iridium seeds). Once the needles have reached the correct area of the prostate they are removed, leaving the radioactive iodine or palladium seeds in place.
This treatment is normally performed under a general or spinal anesthetic so the patient feels no pain, upon waking the patient can feel a dull pain in the area of treatment and patients are normally up and running thirty minutes after the general anesthetic as worn off. Following the operation the patient typically returns home on the same day and follows a course of anti-inflammatory drugs, antibiotics, and drugs to aid in urination.
On the same day as the operation it is common that the patient will undergo a CT scan so that the doctors can ascertain the position of the radioactive prostate seed implants and enable the analysis of the quality of the brachytherapy to be accessed; this may prove very useful for future checks on the condition of the prostate cancer.