Special Conditions for High-Risk Patients
For high-risk patients, a two-month regimen of anti-androgen (anti-testosterone) hormones is used. This regimen is followed by five weeks of external radiation therapy. After five weeks of external radiation therapy, there is a four- to six-week break for the patient. The seed implants are inserted after this break. Once the seeds are implanted, the anti-androgen therapy continues for three more months.
Your patient is considered high risk if:
- Cancer is in clinical Stages II and III.
- PSA is greater than 10.
- Gleason score is greater than 7/10.
The Procedure for High-Risk Patients
With high-risk patients, a regimen utilizing anti-androgen (anti-testosterone) hormones may be used. This is followed by five weeks of external radiation therapy. The patient is then given a four- to six-week break. During the break, approximately two to three weeks before the seed implants are inserted; the radiation oncologist and the referring urologist will use a rectal ultrasound probe to examine the size and shape of the prostate. To ensure accuracy of the insertion, several ultrasound images of the prostate are then recorded.
After the four- to six-week break, the seed implants are inserted. A MedStar Health radiation oncology physicist/dosimetrist then uses a computer to construct a three-dimensional image of the prostate and determine the radiation strength and position of the pellets. Utilizing a three-dimensional image of the prostate allows the doctors to deal with each unique prostate anatomy, in the optimal manner.
When it is time to insert the implants, the doctors use an ultrasound probe to visualize the prostate gland throughout the entire procedure. A template, constructed from the ultrasound pictures previously taken, is placed against the perineum, or the skin located between the scrotum and rectum. Needles that contain the "seeds" are inserted through pre-determined holes in this template, through the perineum, and into the prostate. After ultrasound positively confirms the needle position, the needle is slowly withdrawn and the seeds are left behind in the prostate.
The anti-androgen hormone therapy then continues for about three months after implanting the seeds.
Recovery and Follow-up Care
Most patients can go home the same day of the implant insertion. The urologist and radiation oncologist work together on follow-up care, which typically includes an evaluation after one month, and a visit every three to six months for the first five years to check the seed placement and progress of the treatment.