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Overcoming pubic arch interference in prostate brachytherapy using steerable needles.

Martijn de Vries¹, Sarah L Wilby², Antony L Palmer²

¹Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands.

Journal of Contemporary Brachytherapy

|December 8, 2022

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Steerable needles may allow more patients with enlarged prostates to receive prostate brachytherapy (BT) by overcoming pubic arch interference (PAI). This technology can improve treatment access for patients previously ineligible for BT.

Area of Science:

Urology
Medical physics
Radiation oncology

Background:

Prostate brachytherapy (BT) is a treatment for prostate cancer.
Pubic arch interference (PAI) can prevent some patients from receiving BT.
PAI occurs when the pubic bone obstructs needle placement for source delivery.

Purpose of the Study:

To evaluate the impact of prostate volume (Vp) and patient posture on PAI.
To assess the feasibility of using steerable needles to overcome PAI in eligible patients.
To determine if steerable needles can expand BT eligibility criteria.

Main Methods:

Twenty-seven patients with Vp > 60 cc were studied.
Diagnostic MRI assessed prostate access obstruction in various pelvic positions.

Keywords:

brachytherapy prostate cancer pubic arch interference steerable needle

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Steerable needle access to obstructed prostate volumes was evaluated.

Main Results:

No clear correlation was found between Vp and PAI.
PAI was observed in 23 of 27 patients, with a mean obstruction of 15.2 mm in the supine position.
Patient posture changes and steerable needles significantly improved access, enabling treatment in all cases.

Conclusions:

Steerable needles facilitate prostate brachytherapy in patients with enlarged prostates and PAI.
Curved needle paths overcome anatomical limitations, reducing treatment abandonment.
This technology broadens patient eligibility for effective prostate cancer treatment.