Iodine-125 thin seeds decrease prostate swelling during transperineal interstitial permanent prostate brachytherapy

Abstract

Prostate swelling following seed implantation is a well-recognised phenomenon. The purpose of this intervention was to assess whether using thinner seeds reduces post-implant swelling with permanent prostate brachytherapy. Eighteen consecutive patients eligible for prostate seed brachytherapy underwent seed implantation using iodine-125 (I-125) thin seeds. Operative time, dosimetry, prostate swelling and toxicity were assessed and compared with standard I-125 stranded seed controls, sourced from the department's brachytherapy database. A learning curve was noted with the thin seeds in terms of greater bending and deviation of needles from their intended path. This translated into significantly longer total operative time (88 vs 103 minutes; P = 0.009, 95% confidence interval (CI) 4.1-24.3) and time per needle insertion (2.6 vs 3.7 minutes; P < 0.001, 95% CI 0.5-1.3) for the thin seeds. Day 30 prostate volumes were significantly smaller in the thin seed group compared with standard seeds (40.9 cc vs 46.8 cc; P = 0.001, 95% CI 1.5-5.6). The ratio of preoperative transrectal ultrasound to day 30 post-implant CT volume was also smaller in the thin seed group (1.2 ± 0.1 for standard seeds vs 1.1 ± 0.1 for thin seeds). Post-implant dosimetric parameters were comparable for both groups. No significant differences were seen in acute urinary morbidity or quality of life between the two groups. I-125 thin seeds are associated with an initial learning curve, with longer operative time, even for experienced brachytherapists. The significant reduction in day 30 prostate volumes with the thin seeds has useful implications in terms of optimising dose coverage to the prostate in the early period post-implantation, as well as improving the accuracy of post-implant dosimetric assessments.