Migration of radioactive seeds to the paravertebral venous system after prostate cancer brachytherapy: a case series and literature review.

[BACKGROUND] At our institution, we began using I-125 prostate brachytherapy in 2009. To date, approximately 510 patients have been treated, and we have observed only 14 cases of seed migration. We present three cases of prostate brachytherapy radioactive particles migration to the Paravertebral Venous System with long-term follow up.

[CASE PRESENTATION] Case 1: A 76-year-old male with intermediate-risk prostate carcinoma (clinical stage T2cN0M0; Gleason score3 + 4; prostate-specific antigen level of 18.51) underwent brachytherapy(I-125). Postoperation pelvic CT scan shown one seed were migrated to the Paravertebral Venous System. Case 2: Male, 77 years old, initial PSA 23.75 ng/ml, ECT shown no obvious abnormal signs. Biopsy pathology: (bilateral) prostate cancer, Gleason score 4 + 3, The pelvic CT scan shown one seed was displaced to the Paravertebral Venous System. Case 3: A 77-year-old Male whose initial PSA49.19 ng/ml, ECT shown third lumbar vertebrae bone metastasis suspected. Right prostate gland cancer Gleason score 4 + 5=9. T2N0M1.Endocrine therapy was started immediately post-surgery. Post-operative imaging on day 1 revealed two seeds had migrated into the paravertebral venous system.The patient in case1 who declined endocrine therapy passed away at 60 months post-surgery. The others shows satisfactory results in terms of PSA. Adding endocrine therapy timely may achieve better results.

[CONCLUSION] Although migration of radioactive particles to the paravertebral venous system after prostate cancer brachytherapy is extremely rare, it does not seem to significantly affect treatment efficacy or the long-term prognosis of patients.