INTERSTITIAL BRACHYTHERAPY (IMPLANTING RADIOACTIVE SEEDS) FOR PROSTATE CANCER: AVOIDING OPEN SURGERY
Several transperineal procedures don’t require open surgery at all. One is done just with fluoroscopy (an X-ray image that appears live on a TV screen instead of as a still photograph). Another involves a perineal template like the one described above, and uses CT scanning for extra precision in placing the needles. Over the course of several CT scans, doctors are able to create a three-dimensional image of the prostate. A computerized guidance system helps determine where the seeds should go, how deeply they should be inserted, and how strong their radiation should be.
Many doctors are encouraged by new techniques that use transrectal ultrasound and a sophisticated grid to guide placement of the implants. Like the CT scanner, the transrectal ultrasound enables doctors to develop beforehand a three-dimensional map of the prostate; this guarantees a much more even distribution of radiation throughout the gland. During the procedure, a Foley catheter is inserted through the urethra into the bladder, an ultrasound probe is inserted in the rectum, and needles are placed according to the electronic grid. In this approach, long stabilizing needles are used that don’t have anything to do with placement of the seeds. Because there’s no abdominal incision here, and therefore doctors don’t have full access to all sides of the prostate, they use these needles basically to skewer the prostate and move it around so the seeds can be placed in the appropriate spots. Doctors also use fluoroscopy and ultrasound to double-check the position of the seeds. In some studies, this has been shown to ensure a more accurate, even distribution of the seeds.
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