Preparation and Discharge Instructions for I-125 Prostate Seed Implant Procedure

Pre-surgery physical examination, consent, and instructions

  1. The medication, Flomax 0.4mg should be taken after evening meal- bedtime - starting as soon as possible.
  2. DO NOT take any aspirin-containing drugs, such as Ascription, Ecotrin, Bufferin, Halfprin, for two weeks prior to your implant. Use only plain, over-the-counter Tylenol. If you are unsure whether or not a medication contains aspirin, consult your local Pharmacist.
  3. DO NOT take the following herbs for two weeks prior to your implant: St. John's Wort, Ginseng, Garlic or Ginkgo Biloba.
  4. The evening before the implant, give yourself a Fleets enema 9:00 pm to thoroughly clean out your lower bowel.

The implant procedure

  1. Arrange for someone else to drive you home from the medical center on the day of your implant. Do not drive for at least 2 days after the implant.
  2. DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT.
  3. After the implant, take Decadron 2mg twice daily (example: 8 am and 8 pm) for one week then 2 mg once per day for the second week. Side effect could be increased energy and appetite then after the second week, fatigue.
  4. You will be discharged with a urinary catheter in your bladder. Please read the Discharge Instruction Sheet for further information - catheter remains in place for 48 hours.
  5. A follow-up CT scan, to verify the final position of the seeds, will take place the same afternoon after your implant and again after seven weeks.

If you have any further questions or concerns, please call Carol Halliday, RN at (603) 650-6600.

Discharge instructions

Antibiotics

You may be given a prescription for an antibiotic to take when you arrive home. If so, be sure to take every tablet in the bottle, even if you are feeling better before the prescription is finished. If you begin itching, notice a rash or start to swell on your trunk, arms, legs and/or throat, immediately stop taking the antibiotic and call your Urologist.

Diet

Resume your usual diet when you return home. To keep your bowels moving easily and softly, drink prune, apple and cranberry juice at room temperature. You may also take a stool softener, such as Colace, which is available without prescription at local pharmacies.

Daily activities

  • No driving or heavy lifting for at least two days after the implant.
  • No bike riding, horseback riding or riding lawn mowers for the first month after the implant.
  • Any strenuous physical activity should be approved by your doctor before you resume it.

Sexual relations

You may resume sexual relations two weeks after the procedure. A condom should be used for the first two weeks. Your semen may be dark brown or black; this is normal and is related bleeding that may have occurred during the implant.

Postoperative swelling

Expect swelling and bruising of the scrotum and perineum (the area between the scrotum and anus). Both the swelling and the bruising should resolve in l or 2 weeks. Ice packs and over- the-counter medications such as Tylenol, Advil or Aleve may lessen your discomfort.

Postoperative urination

Most men experience burning on urination and/or urinary frequency. If this becomes bothersome, contact your Urologist. Medication can be prescribed to relieve these problems. Continue to take the Flomax as directed. It is normal to have some blood in your urine for a few days after the implant.

Special instructions related to the seeds

It is unlikely that you will pass an Iodine-125 seed in your urine. However, as a precaution, for the next week, urinate through the strainer that you received when you left the hospital. The seeds are silver in color and are about as large as a grain of rice. If you pass a seed, follow the directions in your discharge kit.

Contact your doctor for

  • Temperature greater than 101 F
  • Increasing pain
  • Inability to urinate

Follow-up

About five weeks after the implant, you will return for a fol1ow-up appointment in the Radiation Oncology Department. At that time, you will have a physical exam, a rectal prostate exam, and a PSA level will be drawn.

General information regarding iodine seeds

  • Iodine-125 is a low energy radioactive material. It is not deeply penetrating and loses energy at short distances. Your prostate will absorb the radiation. Objects that are touched or used by the patient do not become radioactive.
  • Body wastes (urine and stool) or body fluids (saliva, tears, semen or blood) are not radioactive.
  • The Nuclear Regulatory Commission (NRC) has determined that no radiation precautions are needed for patients undergoing Iodine-125 seed implantation. The NRC states that such patients do not present a risk to the people around them, including young children and pregnant women. However, in keeping with the general principle that radiation exposure should be kept as low reasonably possible, we suggest the following:
  • Children and pets should not sit on the patient's lap for the first two (2) weeks after the implant.
  • Pregnant (or possibly pregnant) women should avoid prolonged, close contact with the patient for the first two (2) weeks after the implant.
  • A distance of three (3) feet is acceptable.
  • At a distance of three (3) feet, there is no limit to the length of time anyone can be with the patient.
  • After two (2) weeks, no further precautions are necessary. If you have any questions, please call the Urology Department: (603) 650-6052