Re: Planning a Seed Implant Following a TURP

[Chris Alston <alstonc@odrge.odr.georgetown.edu>]

>From: Wayne Butler <oncology@HGO.NET>
>
>The early Seattle experience used uniform loading for all patients which
resulted in central
>doses of >150% of prescribed prostate dose.  About one third of the TURP
patients, however,
>became incontinent after the implant, compared to less than one percent
incontinence in
>their general patient population.  They concluded that dose was the
critical factor,
>adjusted their TURP patient implants accordingly, and now report
incontinence rates
>comparable to their non TURP patients.
>
>Our preplanning goal is to limit the dose to the epithelium of the TURP
defect to 110% of
>prescribed prostate dose.  DSH's of my actual plans have the surface of
the defect receiving
>between 105 - 125% of prescribed.  We have done only a couple of dozen
such patients, but we
>follow them closely and all have remained continent.
>
>You will need lots of extraprostatic seeds to provide adequate dose
buildup and to make the
>implant robust to a significant likelihood of seed loss into the defect
and out the
>urethra.  In one small prostate with a large defect, 3/4 of the Pd-103
seeds were
>extracapsular.
>
>
>Best regards,
>
>Wayne
>
>**********************************************************************
>
>Wayne M. Butler, Ph.D.
>Medical Physicist                             email:  oncology@hgo.net
>Schiffler Oncology Center
>Wheeling Hospital                             phone:  304.243.3983
>1 Medical Park
>Wheeling,  WV  26003                          fax:    304.243.5047
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