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SBRT prostate with GOLD seeds and gel.

Good day folks. Yes, you read it right...GOLD seeds in your prostate.

Today I will be talking about SBRT prostate. I had done prostate SBRT before over the years but today I would like to share something new in my center using gold seeds and gel for prostate SBRT.

Traditionally when I draw the prostate, I will give a little extra margin for prostate movement during SBRT. However, nowadays I started using seeds and gel with my prostate SBRT to cut down the margins extra so that the side effects from SBRT can be lesser.

Once a patient is diagnosed of prostate cancer and I plan to go for SBRT, I usually refer them to my urologist to insert 3 gold seeds into the prostate for tumour tracking during radiotherapy and gel insertion to separate the prostate and the rectum so that there is a space in between them. This will reduce the radiation dose to the rectum.

These procedures are done as daycare and there is no incision or suturing required. It’s a simple procedure where needles are inserted below the testicles to deploy the seeds and gel under ultrasound guided and the needle is then removed at the end of it.

3 Gold seeds in the prostate
Gold seeds in the prostate for localization during SBRT

Red: Prostate, Yellow: Rectum
Normal location of prostate and rectum (Red: Prostate, Yellow: Rectum)

Rectum is being pushed away from prostate by the gel in between.  (Red: Prostate, Yellow: Rectum, Pink: Gel)
Rectum is being pushed away from prostate by the gel in between. (Red: Prostate, Yellow: Rectum, Pink: Gel)

With these combined techniques, I am able to track the prostate during radiotherapy as prostate moves during radiotherapy with bladder and rectum filling plus the rectum gets pushed away from the radiotherapy field.

The gel will be absorbed by the body in 3 months and the seeds can be kept there lifelong without any issues.

PS: The gold seeds is smaller than a grain of rice so you won’t be able to sell it off for money after SBRT. Hehehe.

Dose distribution for SBRT prostate with seed and gel
Dose distribution for SBRT prostate

From the image above, the yellow distribution is the 100% of radiation dose to the prostate and the blue distribution is the 50% of radiotherapy dose which is conformed closely to the prostate, minimizing dose to the surrounding structure.

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