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Our Long-Term Outcomes with Seed Implant Based Treatment
Florida Center for Prostate Care
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T1c-T2a, Gleason ≤6, and PSA <10 |
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T2b or Gleason 7 or PSA 10-20 |
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High risk: only 1 risk factor
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T2c-T3, Gleason 8-10, or PSA ≥20 |
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High risk: multiple risk factors |
T2c-T3, Gleason 8-10, or PSA ≥20 |
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Possible Side Effects Most men experience only temporary side effects after the implant. Because
there are no incisions or stitches required, there should only minimal discomfort after the procedure. The most common complaint
is temporary irritation of the urinary stream lasting only for a few months. It is common to experience varying degrees of
increased urinary urgency and frequency. Medications can be given to help alleviate these symptoms. Long term side effects
after the seed implant are very uncommon. Unlike surgery, 99% of men are continent and completely able to control their urination.
In addition, up to 90% of men treated with a seed implant can preserve their sexual potency (ability to have erections). By
precisely placing the seeds in the prostate with the Procision™ technique, the incidence of seed migration outside the
prostate is less than 1%. The likelihood of radiation causing any serious damage to any surrounding tissues outside the prostate
is consequently minimal in our hands.
What is the Procision™ Seed Implant Technique?
Why is it so important? To have optimal results from your prostate seed implant, it is essential that all areas of the prostate are
covered with seeds, and that no sensitive areas outside the prostate are implanted. Using the Procision™ Technique,
there is minimal risk of placement of needles or seeds too close to the bladder, rectum, urethra or nerves. Any motion of
the prostate or change in its size or shape during the procedure can be immediately taken into account, ensuring perfect seed
placement. Because seeds are precisely placed in the prostate, the risk of seeds migrating outside the prostate is less than
0.4%.
The Procision™ Technique differs greatly from the much older “pre-planned or Seattle
technique.” The pre-plan technique involves mapping out the prostate a few weeks in advance by ultrasound. Then, when
the patient goes to the operating room, the prior ultrasound is used to determine where to place the needles and seeds. The
pre-plan technique unfortunately does NOT take into account any differences in the size, shape, or position of the prostate
at the actual time of surgery. It has been our experience that the prostate can be very different at the time of surgery.
Subtle changes in leg position, the degree of bladder filling, the use of anesthesia, and the shape of your prostate after
the needles are inserted can have profound effects, making a pre-plan virtually useless. In contrast,
using powerful computers and experience based on thousands of previous cases, the Procision™ Technique takes all of
the above possible changes into effect. All of the needles and seeds are placed based on how the prostate looks at the time
of the procedure, not how it looked weeks before. The doses of radiation to the various areas are calculated live, in Procision™.
Intra-operative computer planning Our physicians have helped pioneer the use of powerful
computers during the implant procedure to instantly calculate the dose of radiation received by the prostate and surrounding
areas. The computer can obtain and analyze live images of the prostate gland throughout the implant procedure to further ensure
optimal seed distribution and placement. This is a major improvement over older techniques where the amount of radiation received
by the prostate could not be determined until after all the seeds were implanted. Currently, no other group in Florida is using this technique.
Case for Combined Treatment
For treatment to be effective in patients who have more aggressive or advanced stages of prostate
cancer, it must be directed at both the prostate and the surrounding areas where cancer cells may have spread. To accomplish
this, a seed implant is typically combined with a few weeks of IGRT (external radiation) and/or a temporary hormone blocking medicine. The seed implant delivers
a high dose of radiation to the prostate, where most or all of the cancer cells reside. The IGRT not only treats the cancer in the prostate, it also attacks cancer cells that may have spread outside the prostate.
Hormone blocking therapyProstate cancer typically feeds on testosterone, the male hormone.
A combination of a shot (Lupron or Zoladex) that you receive every few months from your Urologist, and pills (Flutamide or
Casodex) that you take daily can temporarily block the testosterone in your body. By cutting off the "food supply"
to the cancer, several helpful things can happen: - After a few months, your prostate will shrink 30-40% in size.
In men with large prostate glands, it becomes easier to distribute the seeds for the implant and fewer seeds are required.
An added bonus is that you will probably notice that it is easier to urinate because your prostate is smaller.
- Some
cancer cells outside the prostate may actually die, or "starve to death."
- The remaining cancer cells
can be made more sensitive or vulnerable to the upcoming radiation and thus more likely to be killed.
While
hormone-blocking treatment alone will not permanently rid the body of the cancer, it has been shown to improve cure rates
with radiation in men with more advanced stage cancer. It also has the ability to make the seed implant procedure possible
in men with very large prostates that would have otherwise been technically too difficult to implant. When administered, men
typically take the hormone blocking treatment for two to three months before beginning radiation, and continue the treatment
until after the seed implant. Common side effects from the hormone blockers include temporary hot flashes, fatigue, and loss
of libido.
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