How the Iodine 125” works.

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My friend and treatment

By Dennis Webster

“You have prostate cancer Sir”. This statement can totally consume your life. DON’T LET IT! Prostate cancer management has come a long way and many men are living years after a diagnosis. Early detection generally improves your chances of beating prostate cancer. Radiation is one type of treatment that uses high energy waves like X-rays, gamma rays, protons and electrons beam to treat cancer. Radiation can be given from outside the body (external radiation) or it can be put into or near the cancer in your body (internal radiation). My friend has chosen Prostate Brachytherapy, a kind of internal radiation treatment where they put about 80-100 or more little radioactive seeds directly into the prostate to kill the cancer where it is.

Source: www.emc.org
One common radioactive material they use is called” Iodine125 and it gives off half of its energy every 60 days till all its energy is delivered (in 6 months). A map is used to guide needles (that are pre-loaded with seeds) into the prostate. As each needle is withdrawn, these seeds are dropped in the prostate, one at a time or in strands (more than one together).

Sources:
http://www.brachytherapy.co.za prostatecancer.chesapeakeurology.com

Benefits:
1. It is an outpatient procedure. You go in for the procedure in the morning and you usually leave the same evening.
2. You avoid 6-9 weeks of daily treatment with external radiation. With external radiation treatment, you go in every day from Monday to Friday for a treatment, with a break on the weekend.
3. No surgery (Prostatectomy).

You are generally put to sleep for the procedure although sometimes a spinal anesthetic can be given (“numbs” you from the waist down). Once the procedure is over (roughly an hour and a half), you take your treatment home with you. The seeds stay permanently in your prostate but lose their energy after six months.
Does this mean you are radioactive during that time? NO! Some precautions are recommended and there are side effects from the treatment that are mainly urinary in nature. Your follow up is generally 1 month later at which time you will have:

A chest x-ray
A CT Scan
An MRI Scan
An IPSS assessment

A Total PSA test is generally not taken at your 1 month follow up visit because there is just too much going on in the prostate for the result to be accurate. Many men also experience a “Benign Bounce” (an increase in their Total PSA blood result after the procedure on a few consecutive occasions). The PSA will generally start decreasing after that. Monitoring your progress while on treatment is where Total PSA is valuable.
Some men could experience total blockage of water after the procedure, acute urinary retention (AUR).Trauma from the needles as well as the energy from the seeds irritate prostate tissue. Swelling of some degree has to be expected. Men with larger prostates or who have taken hormones to shrink their prostate prior to the procedure are at increased risk for AUR.
My friend has had the following:

An IPSS assessment (previous article)
An IIEF assessment (previous article)
Flow and PVR (previous article)
Education on Kegel Exercises (previous article)
Information on Intermittent Self Catheterization (previous article)
A Prescription for medications like alpha blockers (previous article)
Pre and Post Procedure Education
A volume study

He is well prepared for his treatment and it will be easier to measure his progress. To see a real (actual case) 3D image of the seeds in the prostate, send a blank e-mail to
seeds@brachy4u.ca
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