Can radioactive seed implants for prostate cancer cause complications like a vesiculorectal fistula?
RECTOURETHRAL. This is one of the most feared, and thankfully rare complications of radiation therapy, external or with seeds. It can occur also in response to treatments for radiation proctitis, when attempts are made to cautering bleeding vessels in the rectum near the prostate. This condition is to be distinguished from a fistula from colon to urinary bladder which is much easier to fix., .
Yes. Having done 1300 seed cases I have never seen this complication. The skill of the doctor is therefore critical. If the seeds end up in the wrong place between the bladder and rectum a hole can develop and the above complication can happen. I am so good at knowing where the needles, seeds and rectum is i will never expect this in my patient. But it is listed in the consent form.
Not if done well. The beauty of a good implant is tht the seeds are "in and around" the prostae capsule, so the dose to the rectum is generally within tolerance. The problem comes when the seeds are maldistributed leading to excess dose to the rectal wall. I've never had this happen in 20 years of implants. (occurred once after cryo and external beam salvage attempt). No idess for gift basket (ur other ?).
Yes. It is possible, but fortunately it is extremely uncommon.
Fortunately Rare. 20 years doing seed implants, I have seen urethro-rectal fisutulas twice, fortunately not in my patients. In experienced hands this should not happen, and careful technique can help avoid this. Today most brachytherapists use axial and sagital ultrasound to ensure proper placement of needles and seeds so these rare complications can be avoided.
Rare. Very rare. Read more...
0.2%-8.8% in 1 study. The absolute answer of the chance of a fistula is, it depends. Having additional therapy such as external beam radiotherapy increases the risk as well as if the brachytherapy was used as a "salvage" treatment for residual cancer. Refer to the article below from the university of virginia: http://www.Ncbi.Nlm.Nih.Gov/pubmed/11066049 other complications: strictures, ed, proctitis, cystitis. Read more...
Very rarely. This is a complication, not a side effect and occurs in less than 1% of implants in most retrospective analyses. These fistulas are usually prostate to rectum and can cause leakage of urine through the rectum as well as chronic infection and pain. Like any procedure, prostate brachytherapy is safe and effective in the hands of an experienced radiation oncologist. Read more...