Does anesthesia method affect implant-induced prostate swelling?
OBJECTIVE
To investigate the impact of anesthesia selection on prostate gland swelling, acute toxicity, and implant quality. The outcome of prostate brachytherapy is dependent on the dose intensity and distribution. Preoperative and intraoperative planning are intended to optimize radiation delivery, but do not account for the impact of postoperative swelling on interseed spacing. Factors that increase swelling can be expected to increase the disparity between the intended and actual dose delivery. General anesthesia has been implicated in increased intraoperative bleeding during prostate surgery.


METHODS
All iodine prostate implants planned and performed by the same radiation oncologist during a defined period were retrospectively reviewed. Excluded from the study were patients who had undergone preimplantation external beam radiotherapy or androgen deprivation. The remaining cases were analyzed to determine any association between the anesthesia type (general or spinal) and an increase in gland volume (from mapping transrectal ultrasonography to immediate postoperative computed tomography), implant quality (dosimetrically determined by minimal dose received by 90% of the volume [D90] and volume receiving 100% of prescribed dose [V100]), and acute toxicity (urinary retention, perineal/scrotal bruising).


RESULTS
A total of 83 implants met the inclusion criteria. The outcomes did not significantly differ in regard to the median volume increase (23% versus 23.5%), D90 (115% versus 113%), V100 (97% versus 96.5%), acute urinary retention (3% versus 4%), or incidence or severity of perineal or scrotal bruising. No correlation was found between anesthesia type and any of the studied outcomes.


CONCLUSIONS
Although only a prospective, randomized trial can definitively answer the question, our results suggest that the anesthesia selection for prostate brachytherapy does not influence prostate swelling, acute toxicity, or implant dosimetric quality.
Aronowitz
Jesse
J
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. aronowij@ummhc.org
Follette
James
J
Moran
Mary Jane
MJ
D000368:Aged; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D001918:Brachytherapy / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011469:Prostatic Diseases / Q000209:etiology*; D012189:Retrospective Studies