Prostate Seeds

I put my stuff on a cart and wheeled on down to the Operating Room. I checked in and put on a bunny suit; a thin disposable paper jumpsuit, booties, and head cover. I parked my cart outside the room and peeked inside.

“Ready for me?” I whispered to a nurse.

“Are we ready for Radiation Safety?” she called out.

The urology Doc, Doctor Meithing, lifted his head and turned toward me.

“Yes,” he said “we think there’s a seed on the floor. We seem to have lost one.”

Ah. This called for the thin crystal detector, the more sensitive of the two I brought. It was about the size of a 16 oz beer can, and was wrapped lengthwise in lead foil to block out any radiation coming from the patient or any other source in the room. I pointed it toward the floor under the patient table and sure enough the analog meter face pegged out high. I turned up the scale once or twice and got a better idea of where the seed might be, then I went to the printer and got a fresh piece of 8 x 11 paper. The Brachy seeds are about the size of a rice grain, and silvery metallic. The floor in this OR was sort of a herringbone mishmash of black, white, silver and grey and there was no way to see a seed on the floor, so I just pushed the paper along the floor and sure enough there it scooped. I borrowed a hemostat from the nurse, picked up the seed and put it in my lead pig (we call the lead containers “pigs” because some do look like piggy banks.)

“Got it.” I said, then I stepped out to put the pig on my cart. I went back in the room to take a few more radiation readings and start filling in my paperwork. Then I quietly moseyed over to the Radiation Oncologist.

“Hey, how’s it going? I asked.

“Not too bad, other than the dropped seed. We’re almost done. Might be a few left over, plus the one you already have.”

Extra seeds could be stored for decay on site in our Radioactive Waste Storage Area or returned to the manufacturer. We used two different isotopes, depending on the treatment plan: palladium or iodine. They had different half lives so the oncologist could choose a short-lived higher dose rate or a longer lived but less intense steady blast of radiation.

As for the operation itself, here’s how it went:

The patient is on his back on the table and under full anesthesia. His feet are in stirrups, legs spread out, ballsack clothespinned to his thigh and an ultrasound wand up his butt. The seeds are lined up in a hollow needle shaft and inserted through the patient’s taint into the prostate. About 45-75 seeds are placed into the gland. Blood drips down from the needle insertion area. After the seeds are placed, which takes a couple of hours, a cystoscope is run up the penis to check the bladder for any wayward seeds. Any bladder seeds are removed with the candiruscope.

Today’s operation had one seed in the bladder, which Doc Meithing removed, six unused seeds, and the one I found on the floor, for a total of 8 seeds for me to bring back to the waste storage room. As the OR staff cleaned up the patient, table, floor, et cetera, Dr. Meithing began his post operation dictation.

“Today we placed – How many seeds went in?”

“Um, Justin, how many do you have?”

“8”

“OK, we ordered 75, so… 67, Dr. Meithing.”

“Today we placed 67 seeds into Patient X’s prostate gland. Patient X is a 72 year old male with prostate cancer. The patient has been undergoing hormonal therapy as well to shrink the prostate. We felt we had excellent seed distribution throughout the gland. One seed was retrieved from the bladder and a thorough examination indicates no other errant seed placement. There were no complications during the procedure and the patient is expected to be discharged today after a three hour waiting period in recovery. Medication will be prescribed as per the operating plan. The operation was a success.”

I checked Dr. Meithing with the thin crystal detector and he left the room.

During and after the operation I also check all over the room for any stray seeds. I check the trash, the laundry, the sterilization room, and the seed preparation area. Today I found no other stray seeds. I always wait until the patient is wheeled out of the room and give it one last check for radiation. While the patient is in the room, he’s putting off too much radiation to check around the operating table. Once he’s gone there’s no hiding it, and I can clear the room for housekeeping to get it ready for the next patient.