Name of the Procedure:

Transperineal Placement of Needles or Catheters into Prostate for Interstitial Radioelement Application (Brachytherapy)

Summary

This procedure involves inserting needles or catheters through the skin between the scrotum and anus (the perineum) and into the prostate gland. These needles or catheters are then used to deliver radioactive seeds directly into the prostate to treat prostate cancer. This may be done with or without the use of a cystoscope, a tool that helps visualize the bladder and urethra.

Purpose

The primary purpose of this procedure is to treat prostate cancer by delivering a high dose of radiation directly to the cancerous cells in the prostate. The goal is to kill or shrink the cancer cells while minimizing exposure to surrounding healthy tissues.

Indications

• Prostate cancer localized within the prostate gland
• Patients with early-stage prostate cancer
• Patients who are good candidates for focused radiation therapy

Preparation

• Fasting for a specified period before the procedure (usually 6-8 hours)
• Stopping certain medications, especially blood thinners, as advised by the doctor
• Undergoing pre-procedure imaging tests like an MRI or CT scan to map the prostate

Procedure Description

1. The patient is positioned on the surgical table, usually on their back with legs elevated.
2. General anesthesia or spinal/epidural anesthesia is administered to ensure the patient is comfortable and pain-free.
3. The perineal area is cleaned and sterilized.
4. Using ultrasound guidance, the surgeon inserts needles or catheters through the perineum and into the prostate gland.
5. Radioactive seeds are placed in the prostate through these needles or catheters.
6. The seeds deliver targeted radiation over time to treat the cancer.
7. The needles or catheters are carefully removed after the placement of the seeds is confirmed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is generally performed in a hospital or a specialized surgical center with facilities for anesthesia and radiology.

Personnel

• Urologist or Radiation Oncologist
• Anesthesiologist
• Nurses
• Radiology Technician

Risks and Complications

• Infection at the needle insertion sites
• Bleeding or bruising in the perineal area
• Temporary urinary difficulty or retention
• Erectile dysfunction
• Bowel problems such as rectal discomfort

Benefits

• Targeted treatment minimizes radiation exposure to surrounding tissues
• Effective control of localized prostate cancer
• Less invasive compared to other surgical treatments
• Shorter recovery time

Recovery

• Patients may go home the same day or after a short hospital stay
• Avoid heavy lifting or strenuous activity for a few weeks
• Follow-up appointments for imaging and blood tests
• Temporary urinary catheter may be required
• Medications for pain and infection prevention

Alternatives

• External beam radiation therapy
• Radical prostatectomy (surgical removal of the prostate)
• Hormone therapy
• Watchful waiting or active surveillance for less aggressive cancer

Patient Experience

• Expect minor discomfort or soreness at needle insertion sites
• Mild to moderate pelvic pain manageable with over-the-counter pain relievers
• Temporary challenges with urination
• Follow-up visits to monitor the treatment’s success and manage any side effects