INTERSTITIAL BRACHYTHERAPY (IMPLANTING RADIOACTIVE SEEDS) FOR PROSTATE CANCER: WHAT COMPLICATIONS CAN CAUSED

Rectal Problems. Several studies report that from 20 percent to 25 percent of men suffered rectal complications, such as diarrhea, cramps or bleeding; most of these problems were not severe. Men who were treated more aggressively (in one study, men with larger, stage T3 or T4, or C, tumors got radioactive iodine seeds plus external-beam radiation) or men who had larger tumors (and therefore got more seeds or a higher dose of radiation) tended to develop more severe rectal problems, such as ulcers. Stool softeners, steroid enemas and anti-inflammatory drugs may help mild rectal ulcers go away, but more serious ulcers that eat away tissue may require reconstructive surgery.

Prostatitis. In one study of 115 patients who had radioactive iodine seeds implanted, five men developed prostatitis (for a discussion of prostatitis, and reported severe irritative urinary symptoms. “Three of these patients were essentially ‘prostate cripples,’ who were truly disabled by their frequent and painful voiding,” wrote two of the investigators. Symptoms in the other two men got better after a TUR procedure (in which many of the radioactive seeds were removed) and long-term regimens of antibiotics. The investigators suspect that in these men, the seeds had become infected.

Urinary Problems. From 10 percent to 37 percent of men in several studies had urinary problems—including urethral stricture, bladder neck contracture, and damage to the urethra—that caused irritative urinary symptoms. Most of these occurred in men who had already experienced such problems (from BPH, for example) or who had undergone a TUR procedure. For example, incontinence, which occurred in 5 percent of men, was not a problem for men who had not had the TUR procedure. Another factor in the development of urinary problems seems to be placement of the seeds—trouble seems much more likely to develop when seeds are planted too close to the urethra. Some doctors are now hoping to avoid this problem by leaving a larger cushion of seed-free tissue around the urethra. However, in sparing the urethra, will they also be sparing some cancer? This is not certain.

Sexual Problems. These can include impotence, ejaculatory pain, pain in the testicles, and blood in the semen. The incidence of impotence seems to have a lot to do with a man’s potency before the procedure. One study, for example, found that only 7 percent of men reported impotence. In other studies, impotence is much more common. Note: In men who have radioactive seeds implanted, a man’s ability to have an erection appears to diminish over time, just as it does in men who get external-beam radiation treatment.

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