BMJ Case Reports 2014; doi:10.1136/bcr-2014-204515

Migration of a strand of four seeds in low-dose-rate brachytherapy

  1. Henry H Woo1
  1. 1Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
  2. 2Radiation Oncology Institute, Sydney, New South Wales, Australia
  3. 3Department of Radiology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to A/Prof Henry H Woo, hwoo{at}
  • Accepted 6 April 2014
  • Published 30 May 2014


We report a case of stranded-seed migration (one strand of four seeds), via the prostatic venous plexus to the internal pudendal vein, in low-dose-rate (LDR) prostate brachytherapy. A 70-year-old man with low-risk prostate adenocarcinoma underwent transperineal permanent seed implantation. A total of 93 iodine-125 seeds were implanted (91 stranded seeds and 2 loose seeds). Immediate postimplantation fluoroscopic image and day 1 postimplantation CT scan indicated all implanted seeds to be within the vicinity of the prostate as planned. Day 30 pelvic X-ray and CT scan revealed migration of a strand of four seeds to the right pelvis (adjacent to ischial spine). At 2 years postimplantation, the patient continues to have good disease control with prostate specific antigen level of 0.69 μg/L, and asymptomatic. To the best of our knowledge, this is the first report of migration of an entire strand of seeds following LDR prostate brachytherapy.

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