Name of the Procedure:

Transperineal Placement of Biodegradable Material, Peri-Prostatic (via Needle), Single or Multiple, Includes Image Guidance
Common Terms: Spacing Gel Placement, Peri-Prostatic Biodegradable Spacer Insertion

Summary

This procedure involves placing a biodegradable gel material around the prostate gland using a needle inserted through the perineum (the area between the scrotum and anus). The goal is to create a space between the prostate and the rectum to protect the rectum during prostate radiation therapy. Image guidance is used to ensure precise placement of the gel.

Purpose

The primary purpose of this procedure is to reduce radiation exposure to the rectum during prostate radiation therapy. By creating a physical space between the prostate and rectum, it helps minimize radiation damage to rectal tissues, reducing side effects and improving the patient's quality of life.

Indications

• Men diagnosed with prostate cancer scheduled for radiation therapy.
• Patients experiencing or at risk of radiation-induced rectal toxicity.
• Cases where reducing radiation dose to surrounding tissues is critical.

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted.
• A pre-procedure consultation and imaging tests (such as MRI or CT scans) are often required to plan the placement accurately.

Procedure Description

1. The patient is positioned and an area around the perineum is sterilized.
2. A local anesthetic is administered to numb the area.
3. Using image guidance (such as ultrasound), a needle is inserted through the perineum to the space around the prostate.
4. Biodegradable gel material is injected through the needle to create the desired space.
5. Image guidance ensures the gel is precisely placed.
6. The needle is withdrawn and the procedure site is cleaned.

Duration

The procedure typically takes about 30-60 minutes from start to finish.

Setting

This procedure is usually performed in an outpatient clinic, surgical center, or hospital's radiology or urology department.

Personnel

• Urologist or Radiation Oncologist
• Radiologist or Ultrasound Technician
• Nurses or Medical Assistants
• Anesthesiologist or Nurse Anesthetist (if sedation is used)

Risks and Complications

• Common risks: Minor bleeding, temporary discomfort at the injection site
• Rare risks: Infection, allergic reaction to the materials, unintended injury to surrounding tissues
• Complications are generally manageable with additional medical care if they arise.

Benefits

• Significant reduction in radiation exposure to the rectum.
• Decreased risk of rectal bleeding, pain, and other radiation-induced side effects.
• Improved overall comfort and quality of life during and after radiation therapy.
• Benefits are typically observed immediately once radiation therapy begins, with the spacer gradually absorbing over time.

Recovery

• Patients can usually go home the same day.
• Mild soreness or bruising in the perineal area is common and can be managed with over-the-counter pain medication.
• Normal activities can typically be resumed within a day or two.
• Follow-up appointments may be scheduled to monitor the spacer and overall therapy progress.

Alternatives

• Watchful Waiting/Active Surveillance: Monitoring prostate cancer without immediate intervention.
• Hormone Therapy: Reducing hormone levels to slow cancer growth, often used in conjunction with other treatments.
• Other Radiation Techniques: Such as Intensity-Modulated Radiation Therapy (IMRT) which can also reduce exposure to surrounding tissues.
• Surgery (Prostatectomy): Surgical removal of the prostate, with different risk and recovery profiles.

Patient Experience

• During the procedure: Numbing of the area will prevent pain, but pressure or slight discomfort may be felt.
• After the procedure: Mild soreness is expected; pain can be managed with medications.
• Immediate return to light activities is typical, with a rapid return to normal routine usually within a few days.
• Regular follow-ups will ensure the procedure's effectiveness and address any concerns promptly.

By understanding these aspects, patients can have a better grasp of what to expect and how this procedure can assist in their overall cancer treatment plan.