Transperineal 125iodine endocurietherapy of prostate cancer

Transperineal palladium 103 prostate brachytherapy: analysis of morbidity and seed migration

OBJECTIVES

To evaluate the early morbidity of palladium 103 (103Pd) prostate brachytherapy.

METHODS

Thirty-two patients with Stage A or B prostate carcinoma were implanted transperineally with 103Pd using transrectal ultrasound and fluoroscopy between May 1990 and December 1992. Patients were subsequently followed to evaluate for morbidity and possibility of migration of the implanted seeds into the lungs.

RESULTS

The median follow-up time was 20 months (range, 2 to 45 months). The major acute toxicity of the procedure, dysuria, was seen in 88% of the patients. Although this was generally grade 1 or 2 and transient, grade 3 or 4 toxicity occurred in 18% of patients. Mild rectal symptoms (transient diarrhea, rectal bleeding) occurred in 19% of patients. Sexual functions could not be evaluated. Seven of the 3213 total seeds implanted (0.2%) were found to have migrated to the lung in 6 of 30 (20%) patients having a postoperative chest radiograph. This did not cause any clinical problems.

CONCLUSIONS

103Pd prostate brachytherapy is generally associated with only mild or moderate urinary and rectal symptoms, and the incidence of severe complications is low. Further follow-up is required to evaluate the efficacy.

Treatment-related symptoms during the first year following transperineal 125I prostate implantation

PURPOSE

To summarize the urinary, rectal, and sexual symptoms occurring during the first 12 months following 125I prostatic implantation.

METHODS AND MATERIALS

Thirty-one patients with Stage T1 or T2 prostatic carcinoma were evaluated for morbidity following computed tomography-guided transperineal 125I implants from 1988 to 1991. The median total activity used was 47 mCi (range 35-73 mCi). Toxicity was evaluated using a modification of the Radiation Therapy Oncology Group grading system.

RESULTS

Nocturia was the most common treatment-related symptom, reported by 80% of patients within 2 months after implantation, and persisted at 12 months in 45% of the patients. Mild dysuria developed in 48% of patients within 2 months of implantation; two patients needed analgesics for their dysuria. Terazosin hydrochloride (2-10 mg qd) provided subjective improvement of urinary symptoms in seven of eight patients in whom it was tried. Rectal urgency, soft stools, and increased frequency of bowel movements was reported by 25% of the patients within 1-2 months after implantation. The incidence of asymptomatic rectal bleeding or ulceration occurring at any time after implantation was 47%, but resolved in all patients with expectant treatment. Self-limited ulceration of the rectal mucosal occurred in 16%, but only one patient developed a prostato-rectal fistula, managed with an ileal conduit. Five of the 18 potent patients experienced discomfort on erection or ejaculation, beginning within several weeks of their implant. The discomfort resolved within 6 months in three of the patients, but persisted for 18 and 24 months in the other two.

CONCLUSION

125I implantation, as performed in this series, is generally associated with only mild-moderate genitourinary and rectal symptoms that may persist 6 months or more after implantation. Prostatic carcinoma, Brachytherapy, Morbidity.