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Brachytherapy

The patient is anaesthetised and placed in the extended dorsal lithotomy position and the transrectal ultrasound used to visualize the prostate and a balloon inflated if required.

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Needles are placed into the prostate through a template which gives coordinates rather like battleships. As each needle is inserted its position on the grid is recorded manually.

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The prostate is visualised by the ultrasound whilst the needles are being inserted. These images are incorporated into the computer screen which is used to plan the implant (20 mins).

Images of the prostate are "captured" from the base to the apex onto the computer software programme, so that the treatment plan can be carried out. Each white flash represents a needle seen in real time ultrasound. The example in these pictures is quite large, around 55cc.

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The positions of the needles are logged into the computer software as they are placed. The prostate, urethra and rectum are outlined in red, green and blue to produce an accurate 3 D interpretation of the patient's prostatic anatomy (30 mins).

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Once the computer knows the position of the needles within the prostate a 3 D Treatment plan can be generated by the computer software (One minute).

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The treatment plan can be adjusted manually to minimise dose to urethra and rectum, but maintaining effective coverage of the prostate to the dose of 145 Gray (10-15 mins).

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Once the needle has been placed into the correct position according to the treatment plan, a very precise surgical instrument, the Mick Applicator is used to push the seeds into position. Each cartridge contains 15 seeds and we implant between 50 and 105 seeds depending on the size of the prostate (25 - 45 mins).

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Seeds are placed under real time ultrasound guidance with careful visualisation of the seed position relative to the prostate and provide a dynamic assessment of the dose delivered.

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Final 3D Dosimetry showing the prostate encompassed by the radiation cloud.

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X-ray view of the implant with seeds in place.
These are painless and over 6 months become inert.

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Patients have no catheter after the procedure, little in the way of bleeding and surprisingly little in the way of discomfort. Patients treated in the morning usually go home in the afternoon. Patients can return to normal activity almost immediately, it takes some weeks for effects of the radiation begin to make themselves apparent. These are generally controlled by simple medication such as alpha blockers to relax the neck of the bladder and maintenance of a high clear fluid intake avoiding caffeine. Patients are monitored by serial PSA blood tests to assess their response to treatment.

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