Brachytherapy for prostate cancer: real-time three-dimensional interactive seed implantation.
A total of 71 men with clinical T1b-T2c carcinoma of the prostate underwent ultrasound-guided interactive seed implantation of the prostate. Sixty received 125I and II 103Pd implants. A laparoscopic lymph node dissection was performed in 58 patients. The patients have been followed a mean of 2 years (1-4.2 years). With use of a prostate specific antigen (PSA) value of 1 ng/ml, patients (n = 8) who presented with an initial PSA of < or = 4.0 ng/ml were all free from failure. This compared with those who presented with an initial PSA of 4.1-10, 10.1-20, and > or = 20 ng/ml, in whom the freedom from failure rates were 52, 32, and 22%, respectively. Patients (n = 49) who presented with an initial PSA of less than or equal to 15 ng/ml had a median PSA of 0.88 ng/ml at last follow-up compared with 2.25 ng/ml for those with an initial PSA of > 15 ng/ml. Prostate biopsies performed 18-24 months after implantation were negative in 82%. The median PSA for those with a negative biopsy was 0.7 ng/ml vs. 4.9 ng/ml for those with a positive biopsy. There were no long-term persistent urinary complaints. Grade 2 radiation proctitis occurred in three (4.2%). No cases of severe radiation proctitis or cystitis occurred. Urinary retention occurred in four patients (5.6%), one of whom required a transurethral resection of the prostate. No patients developed urinary incontinence. Potency was preserved in 94%. We conclude that the real-time ultrasound-guided transperineal seed implantation technique is an effective and safe method of treating prostate cancer. Longer follow-up is needed to substantiate these early encouraging results.
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Department of Urology, Mount Sinai School of Medicine, New York, New York, USA.
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D001706:Biopsy; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D003556:Cystitis / Q000209:etiology; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007205:Indium Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D009367:Neoplasm Staging; D010165:Palladium / Q000008:administration & dosage / Q000627:therapeutic use; D010410:Penile Erection; D011349:Proctitis / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology; D011868:Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000627:therapeutic use; D012449:Safety; D018084:Ultrasonography, Interventional; D014549:Urinary Incontinence / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology
D007205:Indium Radioisotopes; D011868:Radioisotopes; D019275:Radiopharmaceuticals; D010165:Palladium; D017430:Prostate-Specific Antigen