Seattle Prostate Institute

About Seed Implantation -

Radiation Safety: Mention should also be made here about the issue of radiation safety since there are often concerns about whether men are radioactive following an implant and pose a possible danger to those around them. This is not the case. As mentioned earlier, seeds emit low-energy radiation that is absorbed by tissue within a very short distance from seed. In addition, the seeds lose some of their energy every day due to the relatively short half-life of the radioactive materials used in their manufacture (Iodine125 or Palladium103). For these reasons, most of the radiation from the implant will remain confined to the prostate itself. Nevertheless, it is possible that a small amount of radiation will be found at the surface of the skin at the lower abdomen. Patients, therefore, are urged to follow a few simple precautions in the period immediately following the implant. These include avoiding prolonged, close contact with children under 2 years of age and with pregnant women during the first month or two following treatment

Long-Term Complications: An attractive feature of seed implants is the low incidence of long-term complications that can have a serious impact on a man’s quality of life and self esteem. Impotence, incontinence, and rectal injury are the primary concerns of men and their families. These risks are common to all forms of prostate cancer treatment, but there is a general sense that they are less likely to occur with seed implantation.

The probability and severity of any complications will vary from one patient to another and an experienced physician will be able to assess these risks for the individual.

Impotence: According to the American Cancer Society, the loss of sexual function following seed implantation is less than with other forms of treatment. The ACS estimates that, depending on age, 10-30% of men will become impotent as a result of seed implantation compared to 40-60% with external beam radiation and 65-90% with the standard radical surgery. With the “nerve sparing” prostatectomy, the ACS reports impotency rates of 25-30% for men under 60 and 70% for those over 70. At the Seattle Prostate Institute, our experience largely mirrors the ACS findings as illustrated in the following table.

Age	Total Impotence
Less than 60	10%
60-70	15%
Above 70	25%

     Several points should be kept in mind when weighing the risk of impotence with any form of treatment. The first is that regardless of age, a man’s level of sexual function prior to treatment will have a large impact on his sexual capacity following treatment. In other words, a fully potent 70 year old man will have a greater chance of maintaining sexual function following radiation or surgery than would another 70 year old who had been experiencing sexual difficulties prior to treatment. The second item to remember is that potency is not an all or nothing situation. In addition to the men who lose the ability to achieve an erection entirely, there is another group who will experience, to varying degrees, a partial loss of sexual function.

     Incontinence: The loss of bladder control that results in some leakage of urine and the need for absorbent pads is very rare following seed implantation, occurring less than 1% of the time. When it does occur, it tends to be "stress incontinence" in which there is leakage when a man coughs, sneezes, laughs, etc. It is caused by radiation damage to the bladder sphincter, the valve that constricts to keep urine from leaving the bladder.

     Rectal Complications: With patients who have an implant as the only form of treatment, about 2% may experience some temporary, painless rectal bleeding. When the implant is combined with external beam radiation, the rate rises to 6%. The onset of rectal bleeding can be anywhere from 6-18 months following treatment and it can last from a few weeks to a few months. In addition, around 2% of patients who undergo both seeds and external beam radiation may experience more severe rectal difficulties. For the most part, however, these can be treated successfully.