Transperineal Placement of Biodegradable Material, Peri-prostatic, Single or Multiple Injection(s), Including Image Guidance, When Performed

Name of the Procedure:

Common Name: Transperineal injection for prostate cancer Technical/Medical Term: Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed

Summary

In this procedure, a biodegradable material is injected around the prostate gland to protect surrounding tissues during radiation therapy. The material naturally dissolves over time. The injections are guided by imaging techniques to ensure accurate placement.

Purpose

This procedure is primarily used to help patients undergoing radiation therapy for prostate cancer. The biodegradable material acts as a spacer, pushing the rectum away from the prostate to reduce radiation exposure to healthy tissue. The goal is to minimize side effects and complications associated with radiation treatment.

Indications

• Diagnosis of prostate cancer
• Preparation for radiation therapy
• Patients who are at high risk of rectal toxicity due to radiation

Preparation

• Patients may be required to fast for several hours before the procedure.
• Pre-procedure imaging tests such as MRI or CT scans to plan the injection.
• Adjustments to current medications as directed by the healthcare provider, including blood thinners.

Procedure Description

1. The patient is positioned on their back with legs apart.
2. Local anesthesia or sedation is administered to minimize discomfort.
3. The perineal area is cleaned and sterilized.
4. A needle is inserted through the perineum (area between the scrotum and anus) under ultrasound or MRI guidance.
5. Biodegradable material is injected around the prostate gland.
6. Multiple injections may be performed if necessary to achieve adequate spacing.
7. The needle is removed and the site is bandaged.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or surgical center equipped with necessary imaging technology.

Personnel

• Urologist or radiation oncologist
• Nurse or medical assistant
• Anesthesiologist or nurse anesthetist (if sedation is used)
• Radiologist or technician for imaging guidance

Risks and Complications

• Common: Mild pain or discomfort at the injection site, minor bleeding.
• Rare: Infection, allergic reaction to anesthesia, unintended injury to surrounding organs.
• Management: Pain can be managed with medication, and infections are treated with antibiotics.

Benefits

• Reduced radiation exposure to the rectum and other surrounding tissues.
• Decreased risk of rectal bleeding, pain, and other complications from radiation therapy.
• Potential improvement in overall outcomes of prostate cancer treatment.

Recovery

• Most patients can go home the same day.
• Instructions include rest, avoiding heavy lifting or strenuous activity for a few days.
• Pain management as recommended, typically over-the-counter pain relievers.
• Follow-up appointments for monitoring the success of the procedure and planning further cancer treatment.

Alternatives

• External beam radiotherapy without spacer: Higher risk of side effects.
• Proton therapy: Less common and may not be available in all centers.
• Surgery (Prostatectomy): Another treatment for prostate cancer but comes with its own risks and recovery.
• Watchful waiting or active surveillance: If the cancer is slow-growing and causing no symptoms.

Patient Experience

• During the procedure: Minor discomfort from needle insertion, managed by local anesthesia.
• After the procedure: Some soreness in the perineal area, which typically subsides within a few days.
• Pain management includes over-the-counter pain relievers and cold packs if necessary.