Prostate brachytherapy under local anesthesia; lessons from the first 600 patients

Area of Science:

• Oncology
• Anesthesiology
• Radiation Therapy

Background:

• Prostate brachytherapy is a common treatment for localized prostate cancer.
• Historically, procedures like prostate brachytherapy often involved general or deep sedation.
• Implementing local anesthesia aimed to streamline the procedure and improve patient experience.

Purpose of the Study:

• To evaluate the feasibility and efficacy of using local anesthesia for prostate brachytherapy.
• To assess patient tolerance and outcomes with local anesthesia without the need for additional sedation personnel.
• To determine the logistical and cost advantages of this anesthetic approach.

Main Methods:

• Patients undergoing prostate brachytherapy received local anesthesia via lidocaine infiltration.
• Anesthesia was administered directly to the perineal skin, subcutaneous tissue, and around the prostate periphery.
• Transrectal ultrasound (TRUS) guided needle placement for precise anesthetic delivery.

Main Results:

• Over 600 patients successfully received prostate brachytherapy implants under local anesthesia.
• Patients reported a mean pain score of 3 out of 10, indicating good pain control.
• High target coverage (80-95%) was achieved, meeting technical adequacy criteria.
• Routine sedation was discontinued due to positive patient acceptance and effective pain management with local anesthesia alone.

Conclusions:

• Local anesthesia for prostate brachytherapy is well-tolerated by patients.
• This approach offers significant logistical efficiencies and cost savings for healthcare facilities.
• High patient satisfaction and effective pain management support the widespread adoption of local anesthesia for this procedure.