ABSTRACT
The goal of prostate brachytherapy is to induce cytotoxic events by placing radioactive sources into the tumor to mediate an irreversible radiation-induced break in the double strand DNA through free radicals.1 This technique, first described by Pasteau in 19132 and Barringer in 1917,3 involved placement of radium-containing needles into the prostate (Table 9.1). Young performed transperineal brachytherapy in the United States by the 1920s.4 By the 1950s, Flocks et al were placing permanent seeds using radioactive gold-198 (198Au).5 In the 1960s Whitmore et al6 at Memorial Sloan Kettering Cancer Center popularized the open retropubic implantation of radioactive iodine125 (125I) into the prostate by the ‘free hand’ technique combined with pelvic lymphadenectomy. Although this resulted in suboptimal distribution of seeds and poor dosimetry,7,8 this method remained popular throughout the 1980s. Complications attendant to this method included lymphocele, abscess and hematoma formation, pelvic cellulitis, impotence and rectourethral fistulae. The latter complication was most commonly seen in patients who required subsequent transurethral resection of the prostate (TURP) or external beam radiotherapy (EBRT).9
