Transperineal percutaneous iridium-192 implant of the prostate

Interstitial implantation of radioisotopes has become an increasingly popular modality for the management of localized adenocarcinoma of the prostate. Despite the recognized disadvantages, including technical difficulties of accurate seed placement, uncorrectable dose, inhomogeneities in implant volume, limitations in the range of irradiation, and radiation exposure to personnel handling active sources, permanent implantation of either iodine-125 or gold-198 seeds has been widely advocated. A technique of transperineal implantation with afterloading that circumvents many of the problems associated with permanent types of implants is described. Three thousand rad of external beam irradiation was administered three weeks after the implant. Twenty-five patients with clinically localized adenocarcinoma of the prostate were treated with excellent normal tissue tolerance and no major complications. This technique offers excellent control over the implant volume, dose distribution, and radiation exposure to personnel.