Seed Implantation: Specialists and Information

In Germany alone, more than 60,000 men are diagnosed with prostate cancer each year. Prostate cancer is the third leading cause of cancer-related deaths among men.

Seed implantation is primarily used in men with prostate cancer. It has only become established in this country in recent years due to its good results. Like radiation therapy, the procedure uses high-energy radiation to fight cancer cells.

Seed implantation is a type of brachytherapy. In brachytherapy procedures, the radiation source is placed in the immediate vicinity of the tumor or directly into the tumor.

Seeds are tiny radiation sources. During the procedure, the doctor implants up to 80 seeds directly into the tumor.

The implantation is performed under continuous ultrasound guidance and under general or regional anesthesia. To insert the seeds, the doctor uses puncture needles, which are guided to the correct locations in the prostate using a coordinate system.

The seeds remain in the prostate, where they exert their effect on the tumor. The advantage of seed implantation over conventional radiation therapy is the close proximity of the radiation source to the tumor. As a result, the radiation affects significantly less healthy tissue.

More than 70 percent of all prostate cancers are detected at a relatively early stage today. At this stage, the tumors are often still confined to the organ and can be effectively treated.

For some patients, no immediate treatment is necessary. Careful monitoring is sufficient for them.

For other patients, local treatment of the prostate tumor is necessary. Various procedures are available for this purpose:

• radical prostatectomy—that is, the surgical removal of the prostate—or
• various radiation therapy and less invasive procedures, such as seed implantation.

The radiation sources—tiny seeds—are inserted directly into the prostate, where they target the tumor © rumruay | AdobeStock

About a week before the procedure, the team of medical specialists begins planning. To do this, the doctors take transrectal ultrasound images through the rectum. A planning computer uses the images to determine the size, shape, and location of the prostate. Based on this, the radiation oncologist determines the number and position of the seeds.

You must stop taking blood-thinning medications such as ASA, aspirin, Lixiana, or Plavix one week before the procedure. Two days beforehand, you will take an antibiotic and an alpha-blocker.

The procedure takes about 60 minutes. During the procedure, the doctor inserts up to 80 low-emitting iodine-based radiation sources into the prostate. If the treatment is successful, the high-dose radiation from the seeds destroys the tumor tissue from within.

While the patient is under anesthesia, ultrasound images are continuously captured. These images are used to compare the positions of the seeds with their actual placement locations on the ultrasound image. If any shifts occur in the radiation plan, they can be corrected with great precision.

This increases the precision of brachytherapy and, consequently, the success of the treatment.

The procedure takes only about 60 minutes and is minimally invasive. Therefore, patients are treated on a short-term inpatient basis at the hospital. Typically, patients can leave the clinic one day after the procedure and return to work a few days later.

In the initial period following implantation, you should take it easy physically. Avoid the following during the first few weeks:

• swimming,
• sauna visits, and
• strenuous physical and sexual activities.

Also avoid putting pressure on the prostate and perineum, for example by

• sitting on hard surfaces,
• cycling, or
• horseback riding.

A follow-up appointment takes place approximately four weeks after implantation. During this appointment, doctors use a CT (computed tomography) scan to check whether the seeds are still in their intended positions. If any displacement has occurred, it can still be easily corrected at this stage.

Additional urological follow-up examinations are also conducted quarterly. These include

• checking the PSA level,
• ultrasound examinations, as well as
• assessing erectile function and urination.

The PSA level refers to the concentration of prostate-specific antigen in the blood. This value indicates whether changes have occurred in the prostate and whether the protein level is elevated.

An elevated PSA level does not necessarily indicate that the cancer is progressing. Higher PSA levels can also result from an inflammatory reaction in the prostate, such as a reaction to radiation therapy.

Seed implantation is a minimally invasive procedure that places little strain on the body. Imaging techniques such as CT and MRI allow for precise localization of the tumor tissue. This allows radiation oncologists to precisely direct the radiation at the affected tissue, thereby sparing surrounding tissue as much as possible.

Seed implantation achieves good results with comparatively few side effects.

Long-term studies show that the cure rate for this procedure in the early stages of the disease ranges between 80 and 90 percent. Thus, the method represents an equivalent alternative to radical surgery but is significantly less taxing on the body.

In terms of side effects, seed implantation even offers advantages over radical surgery. Patients virtually never suffer from incontinence after treatment. Three years after the procedure, only 10 to 30 percent of treated patients report impotence. This is a significantly lower percentage than with surgery. Although erectile dysfunction does occur, it does not appear immediately as it does with surgery, but rather develops gradually.

Since the physical strain on the body is so minimal, the method has become established in Germany as well as in the United States. Many German clinics and treatment centers already offer this form of prostate cancer treatment.

According to current figures, the 15-year survival rate after the procedure is 94 to 98 percent for low-risk patients. For medium-risk patients, it ranges from 89 to 97 percent.

Due to its good prognosis, seed implantation is a recognized procedure for treating prostate cancer.

In the early stages of the disease, implantation is an option that is comparable to—or even superior to—surgical removal of the prostate. One reason for this is the comparatively few side effects. As a result, the procedure is much less invasive for the patient, and unpleasant consequences of the procedure occur less frequently or later on.