title: Postmortem radiation safety and issues pertaining to permanent prostate seed implantation in Japan.
abstract: OBJECTIVE
  If a prostate cancer patient treated with (125)I brachytherapy dies within 12 months after the treatment, prostate removal before cremation is recommended to avoid problems related to radioactivity in the ashes, such as inhalation of airborne particulate matter by crematorium staff or nearby residents. To provide guidance for such cases, a manual prepared under the editorial supervision of several professional associations was issued in 2008 in Japan. Herein, we investigated the incidence and causes of death, and the actions taken subsequent to death, among prostate cancer patients who died within 12 months after (125)I brachytherapy over a 10-year period in Japan; and we compared the results before and after the manual was issued.
  
  
  METHODS
  Data extracted from the Japan Radioisotope Association database for the period from September 2003 to the end of December 2013 were used.
  
  
  RESULTS
  Of 27,976 patients who underwent (125)I brachytherapy during the specified period, 79 died within 12 months after implantation, including 3 who died in the 2011 earthquake and tsunami. The prostate and brachytherapy source were retrieved at autopsy from 69 of the 79 patients. Autopsy could not be performed on the other 10 patients, 2 of whom died in the earthquake. Autopsy and retrieval of the brachytherapy source were significantly more common after issuance of the manual than before (22/28 cases before; 47/49 cases after; p=0.021).
  
  
  CONCLUSIONS
  In most cases of early death after (125)I brachytherapy in Japan, the brachytherapy source was retrieved.
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. Electronic address: tsatoh@kitasato-u.ac.jp.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Satoh
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiation Oncology, Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan.
authors.forename: Takushi
authors.initials: T
authors.lastname: Dokiya
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Institute for Preventive Medicine, Kurosawa Hospital, Gunma, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Yamanaka
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Urology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ishiyama
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Itami
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shibuya
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Shigematsu
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Aoki
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Egawa
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiological Sciences, International University of Health and Welfare, Tochigi, Japan.
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Yorozu
mesh_terms: D001344:Autopsy / Q000379:methods / Q000592:standards*; D001918:Brachytherapy / Q000379:methods*; D055700:Cremation / Q000379:methods / Q000592:standards; D020878:Device Removal; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D007564:Japan / Q000453:epidemiology; D008297:Male; D017410:Practice Guidelines as Topic; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011835:Radiation Protection / Q000379:methods / Q000592:standards
chemical_list: D007457:Iodine Radioisotopes
keywords: Brachytherapy; Cremation; Prostate cancer; Radiation safety