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50-175 mg) and Versed (3-12 mg). Local anesthetic was given with a mixture of 1% Lidocaine, 0.25% Marcaine, 1:100,000 Epinephrine, and 4% Sodium Bicarbonate neutralizing solution (20-120 cc). Local anesthesia was given to a 5 x 5 cm perineal area to a depth of 10 cm under TRUS guidance. The implants were placed under mobile multi-plane prostate template (Radiation Therapy Products Prostate Template) guidance using from 3 to 4 planes, and 12 to 22 needles. Needle spacing was 1.0 cm. The implant procedure included sigmoidoscopy and cystoscopy. Results: Between 2002 and 2009, 467 TRUS guided prostate implants were performed under local anesthesia. Median implant time was 45 minutes (range : 30 to 150 minutes). HDR treatment was given using the Nucletron afterloading system. The implant volume received 2,250 cGy in 3 fractions prescribed to the 100% Isodose line, given over 24 hours. Urethral dose points (12-16) were followed, and limited to # 105% of the prescription dose. The procedure was well tolerated, with all patients having completed the procedure. Three patients developed respiratory suppression, and required reversal with Narcan. All recovered uneventfully. Otherwise, there have been no acute complications to date. Conclusions: TRUS interstitial implant of the prostate under local anesthesia is feasible. Implant time, complications, cost, and scheduling convenience, compare favorably to general or spinal anesthetic technique.

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