Interstitial high-dose-rate brachytherapy and local anesthesia for prostate cancer: a feasibility report

High-dose-rate brachytherapy (HDR-BT) to treat prostate cancer is usually performed with the patient under general or spinal anesthesia. This report describes how patients tolerate HDR-BT under local anesthesia and provides technical detail, quantifies discomfort level, and summarizes time required for the procedure. Eleven patients with locally advanced prostate cancer, classified as intermediate or high risk, were treated based on an institutional protocol combining HDR-BT and hypofractionated external-beam radiotherapy. For HDR-BT treatments, patients submitted to two weekly implants. To date, we have performed 22 implantations in 11 patients. The dose of lidocaine administered ranged from 250 to 500 mg (median, 300 mg) and pain score ranged from 2 to 6 (median, 3-4). We conclude that HDR-BT for prostate cancer with the patient under local anesthesia is efficient in terms of resource use and personnel time and will facilitate and expand the use of HDR-BT at our institution and others with few beds.