Prostate brachytherapy seed migration to a left varicocele

Area of Science:

• Urology
• Radiation Oncology
• Medical Imaging

Background:

• Transperineal interstitial prostate brachytherapy with loose iodine-125 ((125)I) seeds is a treatment for prostate cancer.
• Seed migration is a rare but potential complication of brachytherapy procedures.
• Monitoring for seed migration is crucial for patient safety and treatment efficacy.

Observation:

• A 73-year-old man underwent prostate brachytherapy with (125)I seeds.
• Pelvic imaging revealed a migrated seed in the left scrotum.
• Ultrasound confirmed the seed migrated to a left varicocele.

Findings:

• This is the first reported instance of seed migration to a left varicocele following prostate brachytherapy.
• The seed likely migrated via the pelvic veins, bypassing systemic circulation.
• The patient remained asymptomatic despite the migrated seed.

Implications:

• This case highlights the importance of thorough post-procedure imaging to detect rare complications like seed migration.
• Understanding the potential migration pathways, such as venous routes, is essential for risk assessment.
• Further investigation into the mechanisms and prevention of seed migration in brachytherapy may be warranted.