Chapter 24: Radionuclide therapy
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Sealed source iodine‐125 seeds used in prostate malignancies
Post‐procedural considerations
Ongoing care
Seeds are implanted permanently into the tissue and the patient must agree to stay in hospital until the physics team states that the radioactivity is at a legally permissible level for discharge. The urine should be checked with the contamination monitor to ensure that the sources have not been expelled in the urine. If no radioactivity is found, the urine may be disposed of in the usual way.
The morning after implant, a CT scan is performed to check the number of seeds inserted and then the urinary catheter is removed. Once the patient has voided normally they may be discharged. Prophylactic antibiotics are prescribed to prevent infections for 5 days after the implant. Anti‐inflammatory medication will also be prescribed to prevent discomfort and swelling.
In the event of accidental or sudden death within 1 year of the iodine seed implant, burial rather than cremation should be performed. It is also advised that burial should take place up to 3 years after implant. If cremation is planned during the 1–3 years post implant, the crematorium would first have to be told to contact the hospital for advice.
Education of patient
Advise the patient to observe for haematoma under the scrotum and give advice on reporting to the medical team. In the first weeks after the implant, the patient may experience dysuria or frequency. They should be advised to drink at least 2 litres of fluid a day and that any haematuria should resolve quickly. It should also be explained that some patients may experience soft stools or some diarrhoea or mucus in the faeces and that generally most of these symptoms disappear within a few days to a week.
The radioactive iodine seeds implanted into the prostate have a very limited range of radiation. This radiation is not harmful to the patient or their family at home and patients can be discharged when clinically stable. However, advice should be given regarding avoiding close contact with small children and pregnant women for the first few months after treatment.
Sexual intercourse is possible after treatment but advise the patient to wait for a few weeks after the procedure. If sexual intercourse is planned in the first 2 months after the procedure, patients should use a condom, in case of the rare occurrence when a radioactive seed may be expelled during ejaculation. For the first few occasions, the colour of the ejaculation fluid may be discoloured, ranging from a light red to black.
For the first few weeks after treatment, it may be possible that one or more radioactive seeds may be expelled during urination. For this reason, patients should be advised to sit down when using the toilet, rather than use a urinal. Any seeds that are expelled will then be flushed away. Patients must be informed not to touch any loose seeds with their hands but if necessary to use a spoon or a pair of forceps. All other social contact and activities can be resumed, including travelling.
