Ultrasound guided implantation of radioactive seeds

The authors discuss the techniques of radiotherapy. Today in most centers seed implantation is carried out as a surgical procedure in combination with a pelvic lymphadenectomy. The latter which undoubtedly increases the complication rate is primarily carried out as a staging procedure. But the status of the pelvic lymph node does usually not influence the decision about whether to proceed with the implantation and there is complete lack of evidence of a therapeutic benefit from the procedure. This to the author would justify the introduction of a new seed implantation technique with a somewhat less precise lymph node evaluation provided that the new technique is less traumatic, time consuming, expensive and possibly more precise than the conventional surgical one. They have at the departments of ultrasound, urology and oncology at the Herlev Hospital attempted to develop such a new technique based upon transperineal implantation of I-125 seeds guided by transcretal ultrasound scanning. The interstitial radiation is supplemented with a reduced external beam irradiation covering the pelvic lymph node. The patients which are offered this treatment are patients with medium or poorly differentiated cancers confined to the prostate