This case involves a 70-year-old male patient who on underwent a prostate seed brachytherapy for adenocarcinoma of the prostate. The treating physician advised that he would insert 40 to 60 radioactive seeds. At the time of the procedure, the physician actually inserted 90 seeds. The seeds were apparently a new, stronger type. During a follow up visit, the patient claimed that he passed 4 seeds. In a follow up visit months later, the patient claimed to have passed 10 radioactive seeds. During the last visit months later, the plaintiff still complained of intermittent severe pelvic / penile pain, difficulty sitting and lifting objects without pain. Plaintiff claims that as a result of the procedure, he has suffered internal burns and nerve damage. The seeds either migrated, spilled out, were not inserted properly, or too many were inserted. Plaintiff continues to suffer pain from the prostate to the penis. He cannot have the prostate removed with the seeds still in place. The pain and injury are believed to be permanent.
Question(s) For Expert Witness
- 1. How often do you perform this procedure?
- 2. What is the standard of care regarding the number of seeds placed?
- 3. Could you review the records and opine on your findings?
Expert Witness Response E-008870
I perform 20-25 brachytherapy per year. I have had patients with urinary complaints for several months but this sounds out of the ordinary. I have reviewed many cases of prostate brachytherapy and most have rare, severe effects like fistula, nothing exactly like this. The crucial determination is whether the total activity implanted was appropriate and whether the sources were placed correctly. These questions can only be answered with a thorough review of all of the records including post implant CT scans and dosimetry.
Expert Witness Response E-008874
I perform several seed implants weekly and we have one of the largest experiences among academic centers in the country for seed implants for prostate cancer.
The number of seeds required depends on the pre-planning or intraoperative planning calculations which further depends on the size and shape of the prostate as well as the location of the disease.