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Question: I have heard that prostate cancer is so slow growing and that some doctors advocate no treatment, particularly with surgery or external radiation. Why should I consider treating it at all and specifically with seed implants?

Answer: Treatment of prostate cancer presents a dilemma. On one hand, many patients do not actually need treatment because their cancer is growing so slowly. On the other hand, prostate cancer is the second most common cause of cancer death in men. With experience, a specialist doctor can reasonably predict how a cancer may behave, but there is no fool-proof way to detect how aggressive a cancer will be in any specific patient. This is why most men choose some type of treatment for early stage prostate cancer.

Because seed implants are significantly less traumatic, and are not associated with the degree of unpleasant side effects and complications that can occur with surgery and external radiation, they may be an excellent choice for many men - even other treatments are rejected. It's an option that should not be overlooked.

Question: My doctor said that radioactive iodine implants were tried many years ago and proved ineffective. Is that true?

Answer: Almost 20 years ago a Cancer center in the USA pioneered prostate implants using iodine 125 seeds. In those days however, these implants were performed using an "open" implantation technique, which involved surgery to expose the prostate gland.

The open technique required the urologist to feel the prostate gland with his fingers to determine where to place the seeds. This was an extremely imprecise method because it relied entirely on the doctor's skill and experience. In many ways the placement of the seeds was poor. Poor placement of the seeds meant that there were areas where the seeds were too far apart, creating "cold spots" in the prostate. Because these "cold spots" did not have a high enough amount of radiation to kill the cancer cells, the cancer returned over time.

Today the guesswork is gone. With the invention of TRUS (transrectal ultrasound) there is now a precise way to guide the seeds in place and ensure that there are no "cold spots" in the prostate. Some specialist doctors also use highly sophisticated CT scans in conjunction with TRUS.

Complications are largely eliminated and recovery time is rapid due to this non-surgical technique.

Specialist doctors who are not familiar with the improved implantation techniques still remember the problems from using the open implant method. But Trinidad & Tobago Prostate Brachytherapy (TTPB) is now performing iodine-125 seed implants using improved implantation techniques.

Question: How do radioactive seed implants compare to radical prostatectomy and external radiation?

Answer: The most recent clinical data shows an equal if not higher percentage of implant patients remaining disease free than with radical prostatectomy or external beam radiotherapy. The average complication rates with radioactive seed implants are less than those for radical prostatectomy and external beam radiotherapy. After a radioactive seed implant there is less incontinence and impotence than with the other treatments.

Question: Will I need a blood transfusion during the implant procedure?

Answer: With the ultrasound guided implant, no incision is made - so no blood is needed.

Question: How long after the implant procedure do I have to wait before returning to work or my regular activities?

Answer: Implant patients are usually ready to return to their regular activities within 3-4 days after the procedure.

Question: Will I have hair loss or nausea and vomiting after the implant procedure?

Answer: No. Even though the prostate cancer receives up to three times more radiation, the effects of the implants are highly concentrated and primarily confined to the prostate.

Question: Can I have surgery or external beam radiotherapy if the seed implant fails?

Answer: Surgery after seed implantation or external beam radiation is often hazardous and rarely recommended. Similarly, seed implantation after failure of surgery or external beam treatment also causes considerable risks.

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