Prostate Seed Implantation


Prostate Brachytherapy, also known as a Radioactive Transperineal Prostate Seed Implantation, is another method of delivering radiation using radioactive seeds implanted into the prostate. This form of therapy delivers photon radiation from the “inside-out,” as opposed to the external beam technologies like SBRT or VMAT that delivers radiation from the “outside-in.”

How is the seed implant performed?

Seed implants are performed as an outpatient procedure at either an ARC facility, and ambulatory surgical center (ASC) or even in a hospital setting – but is always an outpatient procedure – i.e. you will go home that same day. The procedure is performed by your Radiation Oncologist (with occasional involvement of a Urologist.  When you arrive for your appointment, the nursing staff will make you feel at ease. First, they will see if you have any unanswered questions and prepare any paperwork; next you will meet with the Anesthesiologist to review the anesthesia process and ask any questions.  You will be taken to the procedure/operating room where you will be prepared for the procedure and given anesthesia. Once you are comfortably asleep, your Radiation Oncologist will begin the procedure by measuring the exact volume of the prostate in the treatment. Your doctor will then calculate the radiation dose needed based on that volume, utilizing a computerized planning system, which enables a 3-dimensional dose calculation. Once the number of seeds required has been calculated (any can vary from 30 to 100+, depending on the size of the prostate and any planned or delivered external beam radiation). A Foley catheter is also placed when you are asleep so that the urethra, as it passes through the prostate, can be visualized, and seeds/radiation can be planned to best minimize the dose to the urethra.

The Seed Implant process begins with your doctor placing small needles into the prostate gland through the perineum, which is the skin between the scrotum and the anus. The procedure is performed using real-time visualization of the prostate using an ultrasound probe that is placed in the rectum. Once a needle has been placed into the proper position within the prostate, the Radiation Oncologist is able to inject or “load” several radiation seeds through that particular needle, placing each one in an exact location. That needle is removed, and another one is placed in a slightly different but specific position. Once this needle has been loaded and seeds delivered, the same procedure continues until the entire prostate has been implanted with the appropriately determined number of seeds.

Once the procedure is completed, a “rectal spacer” may be placed to move the rectal tissue a bit away from the prostate and the radiation.  Only occasionally, a Urologist will perform a cystoscopy as well to look into the bladder using a special scope inserted through the urethra.   Next you are taken to the recovery area where you will rest until you wake and are more comfortable; and you would be discharged in about an hour or two, Typically, you would be given instructions on the relatively easy removal process of the Foley at home the next morning.