Yes, no matter what happens with seeding or Brachytherapy the actual seeds have to come from America because the company that made them, although it was one of the big National Health companies many years back only makes the seeds in America. And theres two types of seeds, theres the palladium and theres the iodine and the iodine is half strength so it lasts longer but it is weaker. So to get the same radiation effect you say it’s going to last twice as long. They had to be brought from America and when you’ve been surveyed and declared suitable for seed implantation one of the things they do is they, using the ultrasound, they actually measure the volume of the prostate and depending on the volume will depend on how many seeds they’re going to require to put in it because the seeds have to go in at equal spacing across around and all over. And it’s shaped like a walnut, in fact in America there are people who wear badges shaped like a walnut with a ribbon on to indicate that they are prostate people. But having worked it out and in my case it was 62 seeds that were needed they then sent to America who make the seeds and they then, the seeds then come back and you’re given an actual booking and they only come over a day or two before.

How long did it take to get the seeds from America?

Well in my case it was, it was taking 2 months, it has taken longer sometimes I know but 2 months is a reasonable one.

What sort of seeds were they, which ones?

Mine were iodine seeds and they’re the only ones that have been used in England, only ones I believe that still are used really in England for this permanent seed implantation. Now this is permanent seed implantation where they put the seed in and it stays with you for the rest of your life although it’s, to intents and purposes it stops emitting the radiation after about week 53, the actual seeds, so it’s a declining radiation from when it’s put in.

After 53 weeks?

Down to 53 weeks yes. The other higher density seeds definitely in 97 could not be imported under the laws of atomic materials so you could only have the iodine ones at the time I went forward for them.

Are the other ones also left in?

They’re left in as well. Theres a third, theres permanent implantation on one of the two isotopes, the iodine or the P and then theres the high density temporary one where they are put in for may be you know a couple of minutes and pulled out and the next day put in and pulled out again, that’s a totally different procedure. And I know there has, there is one that has started up doing that in UK but at the time I had mine done there was only one and it was doing standard Brachytherapy and permanent implantation.

I must stress about the hospital where I did have the Brachytherapy done was that they’re a total one off within all the NHS ones I’ve come across because they weren’t NHS and the staff had no clue whether you were private or NHS in there, absolutely no clue, you were treated the same and you were treated brilliantly. And everything was explained from the minute you went in the door, absolutely everything was explained which was the first time it had been to me. And I was talking to an NHS patient in there and he was exactly the same, no difference…

(Laughs) well the seeds are implanted every – – – basically in the perineum. They’re inserted on long needles.

Through the perineum?

Yes and you are, you’re actually in a stirrup position

I should explain that the way that the Radiotherapy Clinics of Georgia work is that they use Brachytherapy supplemented by conformal beam radiation so theres Brachytherapy which is the insertion of permanent radioactive seeds into the prostate followed by a period of 6 or 7 weeks external conformal beam radiation.

And how are the seeds actually put into the prostate?

The way the seeds are put into the prostate is that the urologist, through the back passage inserts needles into the prostate and then the oncologist pushes the seeds along the needles and then the needles are withdrawn and the seeds are left inside the prostate. It’s a very difficult job to do well because its very important to space the seeds correctly because if they’re bunched together and not evenly distributed then you can get what they call cold spots, in other words areas in the prostate that are not sufficient irradiated. Anyway the placing of the seeds is absolutely key and they have to be put in very precisely. And it’s up to about 100 seeds that they put in.

Did you start to have any side effects from the conformal radiation?

I had some tiredness may be about half way through and that happened to something like 20% of the patients but it was very mild and I didn’t really have any, I did have some, may be some problems with bowel movements to some extent but that was the only area that I had any problems with and it was nothing serious.

And how long do these seeds go on giving out radiation?

So they have a half life of 60 days, that means that every 60 days they lose half of their strength so I guess you could say after a year that they’ve pretty much petered out.

So what happened after that?

So after that I was required to go back, I was required to have a PSA test after 3 months and then after another 3 months and thereafter every 6 months. The PSA test that I had immediately before the biopsy was 4.4 and I’ve had since then 2 PSA tests. The first one I had in November and the PSA had gone down to 1.0 and I’ve just had another PSA test and it’s gone down to 0.26 (laughs).

So it’s ordinary radiotherapy, external beam radiation?

Ordinary, that’s right yes, yes from three sides, the left, centre and the right.

And you had how many sessions for that?

I had 13 I went every day except weekends for the 13 consecutive visits and the brachytherapy afterwards. I had to wait a week because of problems with the machine, I think, but I went in hospital for 2 nights and had the brachytherapy, but they called it something else I can’t remember what they called it, no I can’t remember what they called it anyway the general term was brachytherapy.

And can you explain in detail about those 2 days when you were in hospital?

Yes, on arrival I was checked over for blood pressure and that sort of thing and I had my last meal on the, on arrival at the hospital, and then the following day I had to go without breakfast because I would be having a general anaesthetic to insert the cannula into the prostate. I was wheeled down the operating theatre and then wheeled back not knowing anything [laughs] just feeling it was a little painful until I was wheeled down to the, to have the brachytherapy where pellets of radioactive material are inserted in to the prostate area for a few seconds and then after that you go back to the ward.

Were you under anaesthetic for all of that?

No.

Just for when they put the cannula in?

Only when they put the cannula in yes.

I was then taken down to the room where the Brachytherapy was going to be provided and there were, I can only assume there were various tubes connected to the cannula because the radioactive pellets went into the various tubes at various times and the whole thing didn’t take very long but it was fitting the various tubes to the cannula and making sure that the connections were there. And then the staff retired and then the machine automatically I think blew the little pellets into the cannula in turn and went back to the machine, and I’m told there was no possibility that one could be left inside because they were all counted before they went in and when they came out.

How does it feel while this is going on, while this is happening?

You don’t actually feel anything. One is observed on a television screen to make sure that one is comfortable and that sort of thing you know and of course you can speak if there are any problems so the staff know, can keep an eye on you while it’s happening but it doesn’t take very long and then you’re disconnected from the machine and then you go up, back to the ward and to my great delight I felt like eating [laughs]. But I had to remain in another night because I would have another session of the brachytherapy before being allowed to go home after that.

So you’re up in the ward, still with the cannula there?

Yes

Is that uncomfortable?

It was very uncomfortable because one was restricted from movement because of the pain but one could bear it because you knew that it was going to be removed the next day so it helps.

So if you lay still it was alright?

That was alright, yes, yes.

So you went back down for one more session the next day?

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