| History of Prostate Brachytherapy modified from HH Holm US in Med & Biol. 1998;20:779-91.,Sem Surg Onc 1997;13:431-37 Dating back to 1901, shortly after the discovery of radioactivity, Pierre Curie of France first suggested the use of radioactive isotopes to treat cancer. Around the same time Alexander Graham Bell made a similar suggestion in America which began the interest in refining the science within the medical community. Two early pioneers of brachytherapy, Henri-Alexandre Danlos of the Curie Institute in France and Robert Abbe of St. Luke's Memorial Hospital in New York tested the idea of shrinking tumors through exposure to radioactive materials. These early developments provided interest into the effects of radiation. In the 1970's several medical centers used brachytherapy to treat prostate cancer. Radioactive sources were placed using an open surgical technique using a hand-placed method whereby the the surgeon would use a finger placed in the rectum to identify the approximate location of the tumor and place the radioactive material accordingly. Long-term follow up of these early cases often provided less than satisfactory results and cancer control could not always be predicted. It is now well understood that these outcomes were the result of 1) technical inability to accurately or precisely place seeds, 2) lack of adequate means by which to estimate the volume of the prostate and develop an effective dose.
Original technique of freehand seed insertion through an open abdominal incision was abandoned because seeds could not be placed uniformly. During the late 80's and early 90's the invention of transrectal ultrasound emerged allowing for improved the evaluation of the prostate. This advancement directly addressed the need for improved volume estimates of the prostate gland. Combined with the developments of template guidance, or precise needle placement of radioactive sources, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) these technical improvements addressed the issues of the early years and advanced brachytherapy as a viable treatment for prostate cancer. Article highlights: “New equipment for transrectal ultrasonomography has been developed... Transrectal ultrasonotomography is a promising new diagnostic technique that yields abundant information not available with former methods of examination. The procedure is likely to become one of the most important diagnostic tools in the field of urology.”
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Intraoperative treatment planning uses a computer in the operating room to measure the exact shape and position of the prostate. |
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Prostascint is an antibody to prostate specific membrane antigen (PSMA). |
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The neurovascular bundles that control erection run on either side of the prostate gland. |
| History and Development of Brachytherapy |
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