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Prostate Brachytherapy (or implant) is rapidly becoming an alternative treatment for early and advanced stages of prostate cancer. AROS provides the Central Valley's only complete and active prostate implant program. We have carried out over 150 implants over the past year (both seed & HDR) well above national implant standards. Prostate Seed Implant--->Click here for information on HDR implants Equipment -- We have the Variseed/MMS seed implant planning
B & K Ultrasound System Seed Needle Loading Chart Experience -- Our radiation oncologist (Drs Ramsinghani), urologists, physicists, nurses and dosimetrists have all completed training at the Swedish Prostate Institute for the seed implant technique.
Patient Selection -- Some but not all patients are
candidates
Implant Process - - Patients will need a special
Above: Patient placement in OR Above: Needle Placement Below: Fluoroscopy and adding extra seeds
Transrectal Ultrasound Guidance: With the aid of the transrectal ultrasound, needles are advanced into the prostate and the seeds deposited at the appropriate depth and location. Our B&K Leopard Ultrasound system is the latest technology and delivers precise transverse and saggital images through the prostate. Below: Transverse ultrasound view Below: Saggital ultrasound view of prostate
Right: Post-implant CT scan & Planning to verify accuracy of implant -->
Prostate HDR Implants
High Dose Rate (HDR) -- HDR implants are delivered via a small radioactive iridium 192 source that can be programmed to deliver a specific amount of radiation for a set time to the prostate. Small plastic catheters are implanted into the prostate under ultrasound guidance similar to the seed implant technique above for 48 hours. No radioactive sources are permanently left in the patient. A five-week course of radiation will follow the HDR implant to the prostate.
Above: HDR treatment tube Above: HDR dummy seeds Below: HDR catheters Below: Placement of catheters
Left: HDR catheters attached to treatment tubes and HDR unit
Results -- Although HDR implants can be given to most prostate patients, the greatest benefit will be those with more advanced cancers that are localized to the prostate. Published studies now indicate that at 5 years, prostate HDR with 5 weeks of external radiation yield PSA-free failures of 84% as compared to 47% for surgery or 8 weeks of radiation of only 47%.
For More Information Contact:
Dr. Veena Ramsinghani
Fresno, California 93720
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system
and the latest in ultrasound seed implant technology. We have the
capability to monitor and modify seed implant process in the operating room with
the 3-dimensional planning system.
for seed implants. Patients with early stage cancer, low PSA
levels (< 10) and low to moderately aggressive cancers are candidates.
Some patients will need hormonal injections and/or hormonal pills prior to the
implant to reduce the size of the prostate gland. A small fraction of these
patients may not be suitable for implantation due to the size of the prostate,
the narrowness of their pubic bones or patient health. Also patients with
a high Gleason score (7 or higher) may require external radiation treatments and
hormone treatments as well.
Gleason Score from
Biopsy 
ultrasound
study 2 weeks before the implant to determine the number and distribution of the
seeds in the prostate. The implant will be carried out under a spinal
anesthetic (like an epidural) and 75-150 seeds will be implanted into the
prostate with 25-40 needles under ultrasound. The procedure takes
approximately 45 minutes and patients may be suitable for discharge the same
day--making the procedure an outpatient procedure in many patients.
Results -- 10yr results now show equivalent long term
success with seeds as compared to surgery or external radiotherapy. Our
implants are assessed post-operatively with a CT scan to confirm the
distribution of the seeds. An 80% score is considered a successful implant
by most centers; we are consistently obtaining results in the 85-99% range.
