Frequently Asked Questions
When considering brachytherapy for prostate cancer treatment, we prefer patients be presented with all their options before making their decision.
What is Jefferson's implant consulting process?
Used as a treatment option for prostate cancer, brachytherapy is a procedure that involves implanting tiny radioactive seeds at the site of the tumor, which, compared with external radiation for prostate cancer, allows for a higher dose of radiation to be safely administered.
What kind of physician typically performs the radioactive seed implantation procedure & in what kind of setting?
Radioactive seed implantation is performed in our hospital setting by a team consisting of a radiation oncologist, urologist and a radiation physicist. This is a highly operator dependent procedure and can reflect on the experience of the team.
What should a patient look for in an implant program?
The implant process is the summation of the skill and expertise of the team, which includes a radiation oncologist, urologist and radiation physicist. Because achieving optimal results with this type of radiation for prostate cancer requires substantial technical skill, patients should look for a program with a proven track record.
At Thomas Jefferson University Hospital we have devoted a great deal of time and energy to our implant program, which is recognized nationally and internationally for the research that has resulted from our work.
Describe the planning procedure.
Imaging of the prostate is the first step, which is performed with a CT and /or ultrasound. These images are used to estimate the number of radioactive seeds that will be required for a successful implant.
On the day of the implant, the radiation oncologist, urologist and physicist perform an ultrasound study of the prostate in the operating room to determine the exact location of each needle and seed. A prostate brachytherapy treatment plan is generated carefully based upon this information.
After a careful review of the treatment plan by each member of the team, a coordinate map of the prostate is created, which describes the location coordinates for needle and seed. This treatment plan is used in the operating room and followed closely. Needle and seed placement is confirmed with both ultrasound and fluoroscopy during the procedure. Additional seeds are available in order to make adjustments at the time of the implant.
Describe the length of the procedure & the type of anesthesia.
Typically, the procedure takes about 1½ - 2 hours and is done under general anesthesia. We prefer general anesthesia because our patients seem to tolerate it quite well. Generally, there is no sensation of pain after the procedure and painkillers are unnecessary.
What can the patient expect to feel like after the brachytherapy procedure?
Patients can expect to feel some tenderness and bruising in the affected area. Most patients require no prescription pain medications. After brachytherapy, most prostate cancer patients are somewhat tired and want to relax. Patients are not limited in their activity level after the procedure.
What side effects might occur days after the brachytherapy procedure & how long do they last?
As a result of the brachytherapy procedure, some men experience mild discomfort in the groin area for two to three days, which is managed very effectively with mild analgesics. Some blood may be seen in the urine and sperm for a few days after the procedure. This is normal and stops after two to three days. The scrotal and perineal area can also become swollen/bruised or black and blue.
The side effects of the radiation from the seeds usually begin one to two weeks after seed implantation. The main symptoms are urinary difficulties, such as frequency, urgency, weak stream or slight pain. These can last for two to six months. These can usually be effectively managed with simple medications.
What are the advantages of permanent seed implantation as compared to other treatment options?
For most patients, seed implantation is a one-time, non-surgical, low-impact procedure. Patient can return to normal activity, including work, within one to three days, with little or no pain.
When else might permanent seed implant therapy be considered?
This procedure is an alternative for men who have early-stage prostate cancer with a low risk of disease outside the gland. Permanent seed implantation is also an attractive option for men whose poor health precludes radical prostatectomy.
Does the radiation from permanent seed implants pose any danger to organs or tissue surrounding the prostate?
Because seeds are implanted accurately into the prostate, they pose little risk to surrounding organs or tissue. The radioactive isotopes used in this procedure (Iodine and Palladium) decay over a period of a few months.
Are breast changes normal?
Yes. Every woman's breasts change during the course of her menstrual cycle, pregnancy, breast-feeding and menopause. Sometimes, however, breast changes such as a change in the size, appearance or feel of your breasts indicates a more serious problem, one requiring a physician's attention.
What kind of breast problems can occur?
The most common breast problems are the presence of benign (non-cancerous) cysts in the breast. Cysts are small, fluid-filled lumps, ranging in size from very tiny to the size of a golf ball. Fibrocystic change, which most often affects women between 25 and 50 years old, may cause your breasts to feel tender and heavy. Medical research links fibrocystic breasts to changes in diet. For some women, caffeine stimulates the formation of cysts. Cutting down on the consumption of coffee, tea, cola beverages and chocolate may help to improve breast symptoms.
Approximately one in eight women will develop breast cancer during their lifetime. The word cancer refers to a group of diseases, all involving the rapid growth of abnormal cells somewhere in the body. Fortunately, breast cancer can be successfully treated when detected early. Yearly physical examinations, monthly breast self-examinations and mammography, if your doctor recommends it, greatly increase your chance to detect breast cancer early.
What if I found a lump?
A breast lump is the first noticeable sign of a breast problem. A lump in the breast can be detected by both you and your doctor by doing a physical exam. The earlier you find a lump, the more successful the treatment of the disease. Because of this, you should get into the habit of performing routine breast self-examination. Women practicing regular breast self-exams discover many of their own breast lumps. During your regular visit, your gynecologist or gynecological nurse practitioner (gyn np) will also examine your breasts for any abnormalities.
How do I perform a breast self-examination?
Make a commitment to do a self-breast examination routinely, every month. Do the exam on the same day each month so that you won't forget. The best time to perform a breast self-exam is 7-14 days after your menstrual period, when your breasts are no longer swollen or tender. If you do not get a menstrual period, then pick a time every month to exam your breasts. Regular self-breast exams will familiarize you with the way your breasts normally look and feel. The following guidelines can be used to help learn how to do a breast exam:
1. Sit or stand in front of a mirror, and examine the way your breasts look. Has either of your breasts changed in appearance or in size or shape? Look for puckering or dimpling of the breast skin, and retraction (pushing in) of your nipples. Then, lift your arms and place your hands on your head, and check the appearance of your breasts again. Finally, press your hands firmly against your hips and inspect your breasts a third time.
2. Now, lie down. Flatten your right breast by placing a pillow under your right shoulder. Place your right arm behind your head.
3. Use the sensitive finger pads (where your fingerprints are, not the tips) of the middle three fingers on your left hand. When doing a breast exam, feel for lumps using a circular, rubbing motion in small, dime-sized circles without lifting the fingers. Powder, oil or lotion can be applied to the breast to make it easier for the fingers to glide over the surface and feel changes to your breast.
4. Press firmly enough to feel different breast tissues, using three different pressures. First, light pressure to just move the skin without jostling the tissue beneath; then, medium pressure pressing midway into the tissue; and finally, deep pressure to probe more deeply down to the ribs or to the point just short of discomfort.
5. Completely feel all of the breast and chest area up under your armpit, up to the collarbone and all the way over to your shoulder and down to your bra line.
6. Use the same pattern to feel every part of the breast tissue. Choose the method easiest for you:
Circles - Beginning at the outer edge of your breast, move your fingers slowly around the breast in a circle. Move around the breast in smaller and smaller circles, gradually working toward the nipple. Don't forget to check the underarm and upper chest areas too.
Lines - Start in the underarm area and move your fingers downward little by little until they are below the breast. Then, move your fingers slightly toward the middle and slowly move back up. Go up and down until you cover the whole area.
Wedges - Starting at the outer edge of the breast, move your fingers toward the nipple and back to the edge. Check your whole breast, covering one small wedge-shaped section at a time. Be sure to check the underarm area and the upper chest when doing a breast exam. After you have completed a breast self-examination of your right breast, examine your left breast using the same method, and your right hand with a pillow under your left shoulder. You may want to examine your breasts or do an extra exam while showering. It's easy to slide soapy hands over your skin and feel anything unusual.
What should I look for when doing a breast self-examination?
Many breasts feel naturally lumpy. This is no cause for alarm. Pay attention to anything that seems new or unusual - new lumps, puckering, dimpling, a thickening or hardening under the skin, a retraction of the nipple, or any other change in the way your breasts or nipples look. Discharge or bleeding from your nipple also signals a problem which needs to be evaluated by a physician.
What if I find something abnormal when doing my self-examination?
If anything abnormal is found after performing your self breast examination, or you notice a change in your breasts, see your doctor immediately to evaluate. If you do not have cancer, you will feel reassured. If you do have cancer, the earlier your doctor can begin treating it, the better your chances for cure.
Your doctor will perform a thorough breast examination, similar to the one you do at home. Based on that exam, and on your medical history, your doctor may recommend further tests to determine the cause of your breast abnormalities found during the exam. These tests include mammography, breast ultrasound, breast MRI or a biopsy.
Can you tell me a little about the Infusion Center?
The Center features spacious, light-filled treatment bays, individual flat-screen TVs and relaxing décor. There are 20 reclining chairs in the unit along with chairs for anyone who may have accompanied you. There are curtains around each unit that can be used for privacy.
The Infusion Center tends to be cold. We can provide blankets if you are feeling chilly or feel free to bring a blanket from home if it will make you feel more comfortable.
Laptops and cell phones are permitted and can provide instructions on how to connect to the Internet through our Hospital Wi-Fi system, Jeff Guest.
Can I bring a family member with me?
On the day of treatment, we encourage you to bring one family member or friend with you. Depending on the length of treatment and medication administered, you may be too tired to drive home. Please understand that many of our patients are at an increased risk for infection from viruses due to compromised immune systems. It is for this reason that a strict policy has been implemented that no children under the age of 16 may be permitted in the Infusion Center unless they are receiving treatment themselves.
Am I allowed to eat before treatment?
There are no restrictions on what you can eat on the day of treatment and you can eat anything during the treatment process. You can bring in your own food or eat what is provided by the Infusion Center. We have snacks, juices, coffee, tea and sodas available at all times and sandwiches are available at lunchtime.
There are also many places outside of the Infusion Center where you may purchase food.
Am I allowed to take my medications on the day of treatment?
If you are taking any prescription medications for any conditions, you are permitted to take those on the day of treatment unless your oncologist has instructed otherwise. If you are unsure, contact your doctor.
Where can I park?
Valet parking is available on 10th street between Market and Chestnut Streets in the Rothman Building. The cost of parking is dependent upon the length of stay. Your parking ticket will be validated at the end of your stay and costs can range anywhere from $2.00 to $4.00. You may also self-park in the Laz Parking Garage on 10th and Chestnut Streets.
What is the check-in process at the Infusion Center?
Upon arrival you will check in on the 2nd floor. At the reception desk, you will see a computer monitor and you need to enter your name in the computer and take a seat in the waiting room. If you have any questions on how to do this, one of the receptionists can help you.
Within a short time, someone will call your name and you will be asked to verify your identity and contact information some questions and asked to provide copies of insurance cards, referrals if needed and any co-pays to complete your registration. Once you have completed the registration process, you take a seat in the waiting room until your name is called to have your lab work done. If you do not have a port, you will be brought back to have a phlebotomist or nurse draw your blood.
If you do have a port, you will be taken into the Infusion Center to have your labs done via your port by an assigned registered nurse.
If you are seeing your physician on the same day of your treatment, you will do that after your labs have been drawn. The physician offices are located on the 3rd or 4th floors.
Once you have completed your physician visit, you will come back to the Infusion Center where you will be seated and treatment will begin.
What lab work will I need done?
Your physician will order blood work to be drawn prior to each treatment to ensure that your lab values are within range to proceed with treatment. Labs will either be drawn from our highly skilled phlebotomists or by a registered nurse if you have an infusaport.
Once the labs are drawn and sent to the lab, it will take approximately 60 to 90 minutes for your physician to get the results. We encourage: You can ask your doctor to have your lab work done several days prior to treatment to avoid the wait time and to speed up your treatment process.
How long can I expect my treatment to take?
The length of your treatment is dependent on the type of chemotherapy your physician has ordered based on your type of cancer.
On your first visit, your chemotherapy is mixed specifically for you and your type of cancer at our onsite pharmacy. The pharmacist does not start mixing the chemotherapy until they receive a checklist from your assigned nurse.
This checklist contains your lab results and weight, which needs to be a certain range for you to receive treatment. If the lab values and weight are acceptable, the pharmacist will mix the therapy. This process can take approximately 30-60 minutes depending upon the type of chemotherapy you are receiving.
Overall you can expect to be there anywhere from an hour to several hours.
Will I need an IV to receive treatment?
When you come in for your treatment a registered nurse will be assigned to you. They will determine whether you require an IV or if you have a port that needs to be accessed.
What happens if I miss my appointment?
If you miss your appointment, please be sure to notify your physician so you can be rescheduled for another time. Please contact your physician’s office directly to reschedule.
What if I am running late for my appointment?
If you are running late, please notify the front desk. The telephone number is 215-955-8874. You will not be cancelled but you may be delayed in being seated.
How many times will I need to receive chemotherapy treatments?
Your physician will discuss your treatment and determine how often you will need to receive treatment. Depending upon your type of cancer, a chemo cycle could be every week, every two weeks or every three weeks.
What is a Complete Blood Count (CBC)?
This is a lab value that helps your physician determine if you are able to receive treatment. It looks at your white blood count, hemoglobin (the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.) and platelets (important for blood clotting). If any of these values are extremely low, treatment may be delayed and you will be rescheduled in a week or so to give your counts time to recover.
If your white blood count is too low, you may receive an injection that will boost your count to prevent you from developing an infection or your physician may put you on antibiotics. If your hemoglobin level or platelet count are too low, you may require a blood transfusion.
Where do I go for blood transfusions if I need one?
If you need a blood transfusion because of a low hemoglobin level or platelet count, a blood specimen is drawn and sent to the Blood Bank so that they can match your blood type.
Once your blood type is matched, a bag is prepared and we are notified that it’s ready. Your physician may order pre-medication (Tylenol or Benadryl) prior to the infusion to avoid a possible blood transfusion reaction. Typically the doctor will order 2 units.
This entire process can take up to 4 hours.
What if I have a problem after I get home?
If you have any issues after you receive your treatment please call 215-955-8874 and you will be directed on what to do.
If it is an emergency, please call 911 immediately or go to the nearest hospital.
What are the side effects of chemotherapy?
You may experience some side effects after receiving your treatment. The most commonly reported symptoms are nausea, vomiting, diarrhea, hair loss, peripheral neuropathies, and fatigue. Before your treatment begins, you will be given anti-nausea medications, which will help you during your stay.
It’s important to remember that everyone is different and you may experience none of these effects, some or all. It’s important to share the side effects with your physician who may be able to help you manage the side effects with medications. If your symptoms are severe, please contact your physician immediately.
Also, the Jefferson-Myrna Brind Center of Integrative Medicine offers an Integrative Cancer Care Program that provides complementary therapies such as vitamins, special diets, herbs and acupuncture that may help with some of your symptoms.
You also have access to oncology social workers who are trained in individual and family therapy and are available to meet with you to assist with the psychosocial impact of cancer treatment, and can provide a valuable link to available community resources.
I understand I may lose my hair after treatment. Where can I purchase a wig?
Jefferson's Wig Program for Cancer Patients was created to help ease the stress and/or embarrassment of sudden hair loss experienced by our patients. If you are being treated for cancer, either as an inpatient or an outpatient at Jefferson, and you have hair loss, we are happy to provide you with a free synthetic wig, turban or hat.
To make an appointment, place call Patient Services at 215-955-7777 or 5-7777 (from inside the Hospital).
How can I receive palliative care?
Palliative care is provided if a person has a serious illness and one or more of the following:
- Patient, family, or team need assistance with complex decision making and determination of goals of care
- Difficult-to-control pain or other symptom distress (such as dyspnea, delirium, nausea) related to a serious medical illness
- Difficult-to-control psychosocial or spiritual issues related to a serious medical illness
- Multiple hospitalizations for same diagnosis
- Progressive decline in functional status
- Progressive metastatic cancer
- New diagnosis of life limiting illness for symptom control or determination of goals of care
- Need for Advance Care Planning or clarification of DNR status
- Utilization of ICU setting in patient with documented poor prognosis
- Prolonged ICU stay or transfer to the ICU setting without evidence of progress
- Questions regarding artificial nutrition or hydration in cognitively impaired, seriously ill or actively dying patients
- Patient or family requests for care determined by primary team to be differences in family and team goals of care
- Patient, family, or team request for information regarding hospice appropriateness
What can I expect?
At Jefferson, palliative care is provided in the hospital and in an outpatient setting. In addition, you can expect:
- Relief from symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping
- Support with emotional, spiritual, or financial stressors that may affect you or a family member during treatment for cancer
- Help carrying on with your daily life
- Improved ability to go through medical treatments.
- Help with understanding your cancer diagnosis and your choices for medical care
- An improved overall quality of life
Will my insurance cover palliative care?
Most insurance plans, including Medicare and Medicaid, cover palliative care. If costs concern you, a social worker or financial consultant can help you navigate through the benefits process.
Here at Jefferson, we want our patients to be as educated and informed as possible when it comes to their cancer care. We suggest you bring a list of questions and a notepad to ensure you get the most information possible during your visit with us. Some frequent questions asked of our radiation oncologists about cancer include:
- What type and stage of cancer do I have?
- How will radiation therapy help me?
- How does radiation therapy work? Is it internal or external?
- How many and how long will I receive radiation treatments?
- What are the chances that radiation therapy will work?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments?
- How can I expect to feel during treatment and in the weeks following radiation therapy?
- Can I drive myself to and from the treatment facility?
- Will I be able to continue my normal activities?
- What side effects may occur from the radiation?
- Will radiation therapy affect my ability to have children?
- What are some of the support groups I can turn to during treatment?