eMedicine Specialties > Urology > Cancer, Prostate

Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy): Workup

Author: Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Coauthor(s): Tracey L Krupski, MD, MPH, Assistant Professor, Department of Urology, University of Virginia
Contributor Information and Disclosures

Updated: Apr 27, 2009

Workup

Laboratory Studies

  • CBC count
  • Prothrombin time
  • Activated partial thromboplastin time
  • CHEM-7
  • Urine culture

Imaging Studies

  • The amount of radiation to be delivered to the prostate and the configuration of the implants must be assessed prior to placement of the implants. As experience with the technique has broadened, the planning and dosimetry stage has evolved from preplanning days to weeks in advance to intraoperative planning. The ABS has defined the following terminology to clarify the differences in the techniques.
    • Preplanning is the creation of a plan days or weeks before the implant procedure.
    • Intraoperative planning is treatment planning in the operating room without moving the ultrasound probe.
    • Intraoperative preplanning is the creation of a plan in the operating room, with immediate execution of the plan.
    • Interactive planning is stepwise refinement of a plan using computerized dose calculations derived from images of needle placement.
  • Intraoperative treatment planning does not eliminate the need for postimplant dosimetric analysis.
  • Key issues related to planning and dosimetry are described as follows:
    • In order to perform accurate dosimetry and real-time visualization of percutaneous source placement, the prostate and margins of adjacent organs (eg, rectum, bladder) must be well visualized. TRUS and CT scanning are the two major modalities currently in use.
    • TRUS has the advantages of real-time imaging and sharp contour of the posterior prostate and rectal wall. Its disadvantage is that its accuracy depends on the operator's skill.
    • The accuracy of CT scanning, on the other hand, does not depend on the operator's skill, but prostate margins are less well defined with this imaging modality.
    • With either modality, initial 5-mm slices are obtained from the base of the bladder to the pelvic floor. A target, which includes the prostate contour, with a generous allotment to the apex and a tighter margin at the base, is developed from these images. The apex tends to allow for less seed migration because of the presence of the pelvic floor muscles here, as opposed to the looser periprostatic tissue at the base.
    • Traditionally, a portion of the seminal vesicles is included in the target of radiotherapy.
    • The information on the target volume and margins is then transmitted to a computer program, and the computer helps perform the dosimetry and helps to plan the number of seeds and to define their location on a 2-dimensional grid.
    • The strategy of seed placement is somewhat controversial, with some advocating uniform distribution of seeds and others emphasizing placement on the periphery of the prostate, where most cancers arise.

More on Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)

Overview: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Workup: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Treatment: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Follow-up: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Multimedia: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
References
Further Reading
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References

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Further Reading

For more information, visit Medscape’s Prostate Cancer Resource Center.

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Keywords

prostate brachytherapy, radioactive seed implantation therapy, interstitial brachytherapy, prostate cancer, prostate adenocarcinoma, adenocarcinoma of the prostate, radioactive implant therapy, prostatic brachytherapy, prostate therapy, adjuvant prostate cancer therapy, seed therapy, iodine-125, palladium-103, organ-confined prostate cancer, organ confined prostate cancer, iridium-192, radiopharmaceutical for prostate cancer, radioactive isotope therapy, HDRB, high dose rate brachytherapy

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Contributor Information and Disclosures

Author

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

Coauthor(s)

Tracey L Krupski, MD, MPH, Assistant Professor, Department of Urology, University of Virginia
Tracey L Krupski, MD, MPH is a member of the following medical societies: American Medical Association, American Society of Clinical Oncology, American Urological Association, and Society of Women in Urology
Disclosure: Nothing to disclose.

Medical Editor

Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Martin I Resnick, MD †, Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine
Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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