Techniques to achieve optimal seed placement in salvage and primary brachytherapy for prostate cancer

To delineate flexible, interactive prostate brachytherapy techniques relying extensively on intraoperative biplane ultrasound and fluoroscopic visualization as developed over a period of 10 years in a brachytherapy program involving more than 2,500 patients treated to date.

Specialized techniques were developed and refined in pretreatment transrectal ultrasound evaluation, interactive seed placement, and postoperative evaluation of implant quality. Special methods were also designed and implemented for treatment of salvage patients and otherwise difficult cases involving large prostates, interfering pubic bone structure, and prostatic defects due to prior transurethral resection of the prostate.

Favorable clinical results, including 79% actuarial disease-free survival at 5 years with low morbidity, have been recently reported in 543 patients with localized primary prostate cancer treated by brachytherapy using the specialized techniques. Promising results have also been recently described in 49 patients who had failed prior radiotherapy and then underwent salvage brachytherapy. Among the techniques found useful were the judicious use of curved stylets and disposable and nondisposable needles, as well as monitoring and minimizing intraoperative prostate movement and compensating for unavoidable movement.

Prostate brachytherapy has attracted renewed interest, largely due to advancements in technique. The presented techniques allow brachytherapy to be performed optimally in a broad range of patients.