Interstitial high dose rate (HDR) brachytherapy under local anesthesia for early stage prostate cancer

14639 Background: Transrectal Ultrasound (TRUS) guided interstitial implant for prostate cancer using Low Dose Rate (LDR) and High Dose Rate (HDR) techniques has been reported with results comparing very favorably to external beam radiation therapy. TRUS interstitial implant of the prostate has been traditionally performed under general or spinal anesthetic in an operating room. We report our results with a technique performed under local anesthesia in a Department procedure room. Methods: Patients with T1 and T2 localized prostate cancer were judged to be candidates for TRUS guided interstitial implant. Results: Between 2002 and 2006, 248 TRUS guided prostate implants were performed under local anesthesia. Conscious sedation consisted of intravenous Morphine (12–22 mg) and Versed (6–14 mg), or intravenous Demerol (50–175 mg) and Versed (3–12 mg). Local anesthetic was given with a mixture of 1% Lidocaine, 0.25% Marcaine, 1:100,000 Epinephrine, and 4% Sodium Bicarbonate neutralizing solution (20–120 cc). Local anesthesia was given to a 5 × 5 cm perineal area to a depth of 10 cm under TRUS guidance. The implants were placed under mobile multi-plane prostate template (Radiation Therapy Products Prostate Template) guidance using from 3 to 4 planes, and 12 to 22 needles. Needle spacing was 1.0 cm. The implant procedure included sigmoidoscopy and cystoscopy. Median implant time was 45 minutes (range: 30 to 150 minutes). HDR treatment was given using the Nucletron afterloading system. The implant volume received 2,250 cGy in 3 fractions prescribed to the 100% Isodose line, given over 24 hours. Urethral dose points (12–16) were followed, and limited to ≤ 105% of the prescription dose. The procedure was well tolerated, with all patients having completed the procedure. One patient developed respiratory suppression, and required reversal with Narcan. He recovered uneventfully. Otherwise, there have been no acute complications to date. Conclusions: TRUS interstitial implant of the prostate under local anesthesia is feasible. Implant time and complications compare favorably to general or spinal anesthetic technique. No significant financial relationships to disclose.