Long-term results of retropubic permanent 125iodine implantation of the prostate for clinically localized prostatic cancer

Outpatient ultrasound-guided palladium 103 brachytherapy for localized adenocarcinoma of the prostate: a preliminary report of 434 patients

OBJECTIVES

To assess the effectiveness of palladium 103 (Pd-103) brachytherapy in Stage T1 and T2 adenocarcinoma of the prostate.

METHODS

Charts of 474 patients treated between 1991 and 1996 with transperineal real-time ultrasound-guided Pd-103 implants were reviewed to assess post-treatment prostate-specific antigen (PSA) levels and follow-up biopsy results. Of 474 patients, 434 had sufficient data for this report. The implant technique used allows precise placement of seeds and accurate dose delivery of the entire prostate. Preoperative neoadjuvant leuprolide (Lupron) and flutamide (Eulexin) were given selectively to reduce prostate size greater than 50 cc and for Gleason grade lesions greater than 7.

RESULTS

Of 434 patients, successful cancer control was demonstrated in 81% of patients by a decrease in PSA levels to less than 1.5 ng/mL at 1 year. Biopsies were negative in 88% of patients 1 year after the procedure and in 89% at 2 years. Analysis of the data suggests that patients with pretreatment PSA levels less than 10 ng/mL had the best outcomes. There were no disease-related deaths; the predominant morbidity was short-term bladder and bowel irritation without permanent sequelae. Incontinence occurred in less than 5% of patients who had undergone prior transurethral resection of the prostate. Impotence occurred in less than 15% of patients.

CONCLUSIONS

The technique used in this study proved effective in reducing PSA levels to less than 1.5 ng/mL and in producing negative biopsies 1 and 2 years postoperatively. Results are comparable to external-beam radiation therapy, demonstrating a significant reduction in morbidity.

Radioisotopic implantation for carcinoma of the prostate: does it work better than it used to?

Transperineal interstitial permanent prostate brachytherapy is being selected as the treatment of choice for early-stage prostatic carcinoma with increasing frequency by both patients and medical practitioners. This trend is surprising to many who are aware of the disappointing results following the retropubic technique of a few decades ago. Others advocate that the newer techniques, which use technologically advanced imaging of the prostate and sophisticated treatment planning systems, allow highly conformal source placement within the gland, resulting in a dose distribution that is superior to that previously achieved. Does improved dose distribution correlate with a higher local control rates in prostate implant patients? This review compares the historical technique of open laparotomy and retropubic implantation as practiced at Memorial Sloan-Kettering Cancer Center in the 1970s to the contemporary technique of transperineal ultrasound-guided permanent seed placement of the 1990s. The results to date show that the present techniques are producing substantially better outcomes, probably resulting from better patient selection as well as improved dose delivery. This is a US government work. There are no restrictions on its use.