Seed brachytherapy requires a lot of detailed and careful planning. Meticulous planning procedures are required to ensure that the correct area is treated and that as much normal tissue as possible is spared from the radiation.

After a decision to use seed implant treatment, we perform a “volume study”.  Detailed instructions about this are given to patients at the time they are booked.  In short, it involves a visit to the William Buckland Centre that will take most of the morning or afternoon (depending on when it is booked).  Patients are given medication which can cause drowsiness hence it is unsafe for men to drive themselves home, and so they have to make other arrangements.

The volume study involves setting men up in the same position that they are placed during the theatre implant.

Figure 1.  Volume Study Set-up

We place an ultrasound probe into the rectum, and then use this to acquire detailed pictures of the prostate gland and the surrounding anatomy in such a way as to be able to reconstruct an exact model of each patient’s prostate, and this surrounding anatomy.  This all takes about an hour.

We can not reliably visualise the cancer with this ultrasound image (in fact, there is no 100% reliable technique available to visualise the location of prostate cancer).  We transfer the images to a planning computer, and develop a computer model and image of the patient’s anatomy.

Figure 2.  Ultrasound image of patients anatomy and dosimetry on the planning computer. 

We then work out with this model how to get a high enough dose of radiation into the prostate to cure the cancer, with the iodine-125 seeds.  We work out how many seeds will be required (on average, just over a hundred), where they should be placed, and how to get them there.

This plan is developed by the physicist and radiation therapist (Figure 2.), and then reviewed by the Radiation Oncologist.  This process can take several days.

We then order the seeds (Figure 3.) which need to be flown out from the United States.

Figure 3.  Iodine Seeds

To accommodate the several steps in this process we allow up to six or seven weeks from the time of the volume study to the time of the implant.

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