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 Who can receive radioactive seed implant (brachytherapy)?

Prostate brachytherapy is the oldest radiation therapy technique for the treatment of prostate cancer. When it was first used to treat prostate cancer, preloaded radium needles were inserted into the prostate and left in the gland for a period of time. Recent advances in prostate brachytherapy have made it another "gold standard" for treating prostate cancer. Prostate seed implant can be used alone for definitive therapy, or it can be used as a boost treatment after external beam irradiation. 

Interstitial brachytherapy has been employed for patients with T1 and T2 tumors. Patients are selected for favorable characteristics, including low Gleason score, low PSA level, and stage T1 to T2 tumors. Patients with more advanced disease may receive brachytherapy as the boost treatment after external beam radiotherapy. Implant therapy alone is not recommended for patients with high Gleason score, high PSA level, or stage T3 or above. Information and further study are required to better define the effects of modern interstitial brachytherapy on disease control and quality of life, and to determine the contribution of favorable patient selection to outcomes. 

There are two different types of radioactive seed available currently, Iodine-125 and Palladium-103 seeds. Both implants release low energy radiation over a short time period. Palladium gives off its energy in approximately 3 months, and for Iodine implant, 6 months. There is no clinical evidence that one implant is more effective than the other; however, Palladium implants are used to treat more aggressive disease (i.e., higher Gleason Scores) by some investigators. 

One of the important advantages of radioactive seed implant is that it has less side effects compare to external beam radiation or surgery. Long term side effects such as impotence occur less frequently after brachytherapy. There is generally no incontinence, diarrhea, or abdominal discomfort following seed implantation. Rates of erectile dysfunction after radioactive seed implants often correlate with the age of the patient. Impotence is rare for fully potent patients younger than 60. For patients older than 70, radioactive seed implant may cause impotence in about 30-50% of cases. This rate is still much lower than radical prostatectomy. 

For implant radiation therapy, a brief stay in the hospital may be needed when the radioactive material is implanted. The implant may be temporary or permanent. When a temporary implant is removed, there is no radioactivity in the body. The amount of radiation in a permanent implant is not generally dangerous to other people, but patients may be advised to avoid prolonged close contact with others for a period of time.

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