faqs

Frequently Asked Questions

What is a stereotactic transperineal biopsy (STPB)?
STPB is performed by taking a median of 40 samples of the prostate through the perineum while the patient is under general anesthesia. Performed as an outpatient procedure, it allows more comprehensive sampling compared to the transrectal method, which takes fewer samples through the rectum. In addition, by taking more samples during STPB, the exact location of the cancer can be pinpointed.

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What is the difference between an office biopsy and a stereotactic biopsy?
The standard office biopsy is done under local anesthesia and uses a rectal approach, taking from 10-14 samples. The stereotactic biopsy performed at CPC is done under general anesthesia thru the perineum (just above the rectum and below the scrotum), and takes anywhere from 20-80 samples depending on the size of the patient's prostate.

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How long does it take to get results from the stereotactic biopsy?
We usually have results in 3-5 working days.

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What is a volume study?
This is an ultrasound study of the prostate to determine the exact size and shape of the gland. Pictures or images of the prostate are taken and used to design each patient's individualized treatment plan. At the conclusion of the volume study, the radiation oncologist will decide if a patient is a candidate for seed implantation.

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If a patient has an ultrasound with his biopsy, does he still need a volume study?
Yes. The volume study is used to measure the size and shape of the prostate gland which is essential to planning the placement of the seeds. Unlike the biopsy, there is no needle used and no specimen is obtained during a volume study.

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How soon after the volume study may a patient have the seed implant?
If a patient and his radiation oncologist decide that the patient is a good candidate for a seed implant, the procedure usually can be scheduled in two to four weeks following the volume study.

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If a patient's cancer has spread beyond his prostate, can the patient still have a seed implant?
Seed implant may still be a treatment option for the patient in combination with other treatment modalities. The patient will need to consult with his radiation oncologist.

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Can a patient drive himself home after a volume study or does he need someone to drive him home?
During a volume study, there is no anesthesia used so a patient may drive himself home afterward.

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Can a patient drive home after a seed implant?
No. Because the patient is given general anesthesia in conjunction with the seed implant. Therefore, the patient will need to have a responsible adult drive him home.

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How long does the seed implant take?
Although the actual seed implant takes approximately one hour, a patient will be at the Center for three to four hours total. It is a one-time, outpatient procedure.

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How long do the seeds stay in the body?
Although the seeds remain in a patient's prostate forever, they only remain active for a certain period of time, depending on the type of seed used.

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What is the difference between the Cesium131, Iodine125 and Palladium103 seeds?
The main difference between these sources is the time in which the radiation is delivered. All 3 isotopes are short-lived or decay rapidly, meaning they deliver the required dose in a short amount of time. So far, the cure rates within all 3 isotopes appear to be equal. Chicago Prostate Center is one of the few prostate cancer treatment centers that offers all 3 isotopes.

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How does Chicago Prostate Center decide which type of seed to use?
The radiation oncologist will choose the optimal plan for each patient, taking into consideration many factors including the size and shape of the prostate gland, Gleason score, age, other health conditions, etc.

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What kind of physician typically performs the procedure and in what kind of setting?
Prostate seed implantation is performed in an outpatient setting by a team of physicians consisting of a radiation oncologist, urologist and an anesthesiologist. A radiation physicist and certified medical dosimetrist are involved in the treatment planning.

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Are there any side effects from seed implantation?
After a seed implant, it is common to experience some urinary symptoms. Common urinary symptoms are: frequency (a need to urinate more often), urgency (a strong desire to urinate), a decreased force of the urinary stream and difficulty starting the urinary stream. A small percentage of patients (less than 7%) may require a catheter or intermittent self catheterization for a short time.

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When can a patient resume sexual activity after the implant?
A patient may resume intercourse when ready, with the recommendation that a condom is used for the first two weeks following the implant.

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When can a patient return to work?
Most patients only take a day or two off work. We do not recommend lifting over 10-15 pounds for the first 2 weeks after the procedure. This is a minimally invasive, one-time, outpatient procedure with no incisions or stitches.

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If a patient had a TURP in the past, may the patient still have a seed implant?
A patient may still be a candidate if only a small amount of tissue was removed. In fact, we have safely treated hundreds of patients who previously had a TURP in the past. A patient will need to consult with his radiation oncologist.

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Are there any restrictions regarding how close a patient who receives a seed implant may be to a pregnant woman?
Pregnant women should maintain a distance of 3 feet (about an arm's length)from the patient, for 2-6 months, depending on the isotope that the patient received. At this distance, there is no limit on the time a pregnant woman can spend with a patient who received prostate brachytherapy. There are no special precautions for a spouse, family member, pet or the general public. Detailed, written instructions are given to each patient after his implant. This information is based on recommendations from the American Association of Physics in Medicine.

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Many patients have grandchildren that they see often. Are there any special precautions such patients should take after the implant?
A patient who received prostate brachytherapy should limit the amount of time that a child sits on his lap to 5 minutes per day for 2-6 months, depending on the isotope that the patient received. With this precaution, there is no limit on the time that a patient may spend with children. There are no special precautions for other family members, pets or the general public. Detailed, written instructions are given to each patient after his implant. This information is based on recommendations from the American Association of Physics in Medicine.

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Does the radiation from seed implants pose any danger to organs or tissue surrounding the prostate?
The seeds are implanted with accuracy and they pose minimal risk to surrounding organs or tissue.

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Are patients radioactive after the seed implantation?
No. Although the seeds are radioactive, patients are not. Since the radioactivity has low energy and the placement is so precise, virtually all the radioactivity is absorbed into the prostate. There is no radioactivity in a patient's blood, sweat, urine and other bodily fluids. There are no issues with contamination.

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Will the seeds that are implanted set off alarms like the ones at the airport?
No. The seeds are titanium, similar to other pins or clips used in medical procedures. There should be no problem with security systems or metal detectors.

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Can a patient have an MRI or CT Scan if the patient has had a seed implant?
Yes, the seeds are titanium, similar to other pins or clips used in medical procedures. There are no contraindications to MRI or other scans.

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Can a patient have a colonoscopy if he has had a seed implant?
Yes, it is safe to have a colonoscopy, however, we recommend waiting 6 months after the seed implant before having a colonoscopy. A patient should always inform the physician performing the colonoscopy that the patient has had a prostate seed implant. If a patient needs a colonoscopy procedure urgently, the patient's gastroenterologist should speak with the patient's radiation oncologist.

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Is this procedure covered by insurance?
Most private/commercial insurance companies allow benefits for this procedure and Medicare approves the seed implant as well. We contact each patient's insurance carrier to verify benefits and coverage and we will pre-certify the procedure, if necessary. If we are out-of-network with a patient's insurance plan, we discuss payment options with a patient in advance of treatment.

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What is a post plan (brachytherapy isodose calculation) and why is it performed after the implant and after a patient leaves the facility?
A post plan begins with the results from the patient's CT scan and then is transferred to our treatment planning software. Our physics staff, with the use of this software, performs a replication of the seed implant using the CT images. These images are then compared to the pre-implant dosimetry plan. The post plan results provides the physician with the final radiation dose results, and confirms the prescribed dose was delivered to the prostate and surrounding organs. This is the final step in every seed implant. This will be a part of the patient's permanent medical record and may be requested in the future for other medical planning. This charge will be billed the date that the physician approves this final analysis.

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What is the difference between the intraoperative planning and pre-planning technique?
Intraoperative planning is when the prostate is measured and dose is calculated to deliver the proper amount of radiation in the operating room on the same day as the implant procedure. Pre-planning is very similar in that measurements of the prostate are taken 1-2 weeks prior to the day of implant. The radiation is calculated accordingly. We prefer pre-planning because the prostate really does not change its shape or size and therefore, accurate measurements can be taken to ensure the proper number of radioactive seeds are ordered, allowing for additional quality assurance prior to the actual implant. Furthermore, pre-planning is very efficient, requiring essentially no additional time for the patient who is under anesthesia during an implant.

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