Improved Technique for Prostate Seed Implantation: Combined Ultrasound and Fluoroscopic Guidance

Abstract

Long-term results of irradiation by iodine 125 (^l25I) seeds surgically placed in the prostate indicate that this is a reasonable approach for certain small well-differentiated cancers. Unfortunately, the key element of this technique, the accurate placement of seeds, could never be achieved with any reliability or consistency. This report presents experience with 50 patients treated with ^l25I prostate seed implantation using either ultrasound guidance alone (19 patients) or ultrasound plus fluoroscopic guidance (31 patients). Postimplant dosimetry studies revealed that overall, 47 of 50 patients (94%) achieved satisfactory dose distribution. Under ultrasound guidance alone, 16 of 19 had satisfactory seed distribution (84%), whereas using combined fluoroscopy with ultrasound, 100% achieved satisfactory dosimetry. At 1 year, 12 of 15 patients (80%) who were potent preoperatively maintained their potency. Addition of fluoroscopy to the ultrasound-guided transperineal seed implant procedure improves thejaccuracy of seed distribution, is well tolerated, and should further improve results.