Urology Experts Discuss Injuries From Improper Placement of Brachytherapy


Urology Expert WitnessThis case involves a middle-aged man who was diagnosed with prostate cancer and elected to undergo treatment via brachytherapy in West Virginia. During the procedure, the doctor failed to correctly place the radioactive seeds into the patient’s prostate, instead placing some of the radioactive material in his perineum. As a result, the man’s urethra was apparently damaged, leaving him incontinent and unable to urinate normally. As a result, the man was forced to use a catheter in order to urinate. Additionally, the patient’s cancer continued to progress due to his botched treatment.

Question(s) For Expert Witness

  • 1. How frequently do you perform Transperineal Seed Implementation to Prostate procedures?
  • 2. What is the efficacy of the seeds located at the base of the penis in terms of treating cancer inside the prostate?
  • 3. What might be some treatment options left for this patient given that the seeds remain at the base of the penis?

Expert Witness Response E-014229

Currently, I perform seed implantation fairly infrequently – maybe once or twice yearly. In the past, I would perform approximately 3 – 4 cases monthly. The efficacy of seeds located at the base of the penis would be low – probably never studied since this is not the anticipated destination of the seeds. The radiation oncologist, dosimetrist, and physicist should be able to calculate the exact dose delivered to the prostate. There still may be an option for external beam radiation therapy if the target is outside of the area already treated. Cryotherapy could also be used but may cause more damage urethra and bladder neck. Given the urethral damage already sustained, if prostate removal were considered, the patient would probably require a urinary diversion.

Expert Witness Response E-112803

Regarding outcomes for prostate cancer treatment with brachy seeds, it depends on a number of factors. Specifically the Gleason Score, Pre-treatment PSA, stage of disease, prostate size, and pre-existing lower urinary symptoms. Regardless, as cancer can be treated, it is a disease that requires life-long surveillance as it can recur no matter what treatment option is chosen. The seeds can not be removed without a very morbid operation. Treatment for urinary problems primarily depend on the cause. Radiation typically causes urinary urgency and not an inability to urinate. An inability to urinate can occur from neurological or muscular deficits, neither of which occur as a result of radiation except perhaps in extreme cases. There are no technologies which have been proven to make a bladder squeeze again when it ceases to. In the situation where the bladder is no longer squeezing the options are for an indwelling urethral catheter or intermittent catheterization or a tube that is placed through the skin directly into the bladder that stays there.

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