SIDE EFFECTS & COMPLICATIONS OF SEED IMPLANTS?

     The most appealing aspects of seed implants are the convenience of a single outpatient treatment, the rapid return to normal activities (usually within 2-3 days), the lack of significant pain or discomfort during and after the procedure, and the relatively low frequency of serious side effects and complications. This has been the experience of the great majority of patients at SPI.

     Like other approaches to treating prostate cancer, there are certain short and longer term side effects associated with seed implantation. They mainly have to do with urination and result from

the fact that the seeds can remain radioactive for up to one year during which time the urethra receives some radiation. These urinary symptoms gradually disappear over time as the seeds lose their radioactivity and, if necessary, they can be treated with a variety of prescription and over-the-counter medications.

Short-Term Side Effects:  During the first few days following an implant, patients will experience temporary side effects that are mostly due to the fact that you had a catheter in place for an hour or so and had needles inserted into the prostate. These side effects usually consist of a burning sensation when urinating (which may be intense the first day), bruising and tenderness between the legs when sitting on a hard surface, and some blood or small clots in the urine. Less commonly, patients may experience a slow and erratic urinary stream and a strong sense of urgency when the need to urinate arises. Pain, other than the tenderness when siting, is very uncommon. Although patients are given oral pain medication when they leave the hospital, most never need to take it. The side effects of burning on urination, tenderness between the legs, and blood in the urine usually subside rapidly over the first week following implantation. Also during this period, strenuous physical activity should be avoided and medications need to be taken as directed.

Urinary Symptoms: Beyond the immediate recovery period, remember that the seeds are giving off radiation for many months to treat the cancer before they become inert and are no longer radioactive. During this period, patients are expected to have temporary side effects from the seed radiation that are mostly urinary in nature. Most patients describe three urinary side effects for several months: (1) Frequent urination (about every 2-3 hours day and night), (2) Urgent urination (when you need to go, you will need to get to the bathroom in just a few minutes), and (3) Slower urination (the urinary stream is weaker, slower, more difficult to start, and may dribble). Pain with urination is rare but some patients report mild burning when they first start to urinate. Incontinence, or leaking urine, is almost never a problem after seed implants unless you cannot find a bathroom in time when you have the urge to urinate.

   The severity of these temporary side effects varies greatly from patient to patient. Most patients describe these problems as mild enough to be a temporary inconvenience that does not modify their lifestyle. Rarely, patients do experience these problems to a more severe degree. These patients may have certain conditions of the prostate or bladder that makes them more likely to have problems after a seed implant. If you have these conditions, your doctor will discuss this with you at the time of your consultation.

   The time that these side effects last also varies from patient to patient. Generally, the urinary problems peak around 3-8 weeks after the implant and then begin to gradually improve. The average time for the urinary side effects to disappear completely is usually about 6-10 months. Some patients are fortunate and they are back to normal in 3 months while others may take 12 or even 24 months. In the end, the majority of patients feel their urination has returned to the same level it was before their seed implant.

Catheterization: One of the problems some men face in the first month after a seed implant is the need for a urinary catheter due to a temporary inability to urinate. (A catheter is a small rubber tube inserted through the penis into the bladder to drain urine, usually into a small plastic bag strapped to the leg under the pants.) This problem is caused by the swelling of the prostate that occurs following a seed implant. On occasion, the swelling can constrict the urethra to the point where urine can no longer pass through it, leaving the patient unable to urinate. This happens to about 1 out of every 10 men who have a seed implant. Depending on other conditions of the prostate, your risk may be higher or lower. Your doctor will discuss your particular risk for a catheter. If a patient needs a catheter, it usually happens 1-3 weeks after the implant. The need for a catheter is rare right after the implant and very rare beyond 1 month. The average time a catheter is needed is about 2 weeks. Rarely (2% of patients) the prostate swelling is prolonged and the catheter is needed for several months. There are a few patients every year who eventually need minor surgery to open the urinary passage because of this blockage, but the vast majority never have to face these problems.

Rectal Side Effects: Seed implantation rarely has any serious impact on bowel function. In the first few weeks after the implant, about 10% of men report having 2 or 3 normal bowel movements a day instead of their usual 1 a day. Some say they have difficulty sensing a bowel movement and will sit when urinating as a precaution. These effects, if they occur, only last a few weeks and then bowel movements return to normal for almost everybody.

Sexual Activity: Many patients inquire about resuming sexual activity following a seed implant. Your doctor will review the possibility of impotence. Following the trauma of the seed placement and the inflammation caused by the seed radiation, many patients are uninterested in sexual activity for several weeks or months. However, it is permissible to resume sex shortly after the implant. Remember that the seeds do not make any bodily fluid radioactive (either urine or semen), so there is no danger of radiation exposure to the partner. If sexual activity is attempted soon after the implant, be prepared for a burning pain lasting for a few minutes after ejaculation and blood in the semen. This is very similar to the effects of a prostate biopsy. This discomfort is not dangerous and will not affect your implant but can be disconcerting. Some patients worry that a seed could be passed with the semen during ejaculation and contaminate their partner. This is an exceedingly rare occurrence and even if it did happen, we do not believe it would cause harm. However, to prevent this rare possibility, we recommend that a condom be used during the first half-life of the seed (3 weeks for Palladium-103, 2 months for Iodine-125).