Evolution of techniques for ultrasound-guided palladium 103 brachytherapy in 950 patients with prostate cancer.
OBJECTIVE
Brachytherapy is an effective, low-morbidity, cost-effective treatment for adenocarcinoma of the prostate. Although both iodine 125 and palladium 103 have been used extensively over the last 14 years, 103Pd (Theraseed) provides a more rapid initial dose and therefore better control of higher Gleason grade tumors. We assessed a highly refined methodology for 103Pd brachytherapy in patients with prostate cancer and compared outcomes before and after making adjustments in technique.


METHODS
Standard brachytherapy techniques were modified to include combination of preplanning with real-time adjustment, placing all needles at once to minimize prostate movement, using monitored anesthesia control sedation during preoperative volume study and cystoscopy, and several other small but important changes. Charts were reviewed from 950 patients treated with 103Pd implants from 1991 through 1999. Prostate-specific antigen (PSA) and biopsy data before and after 1993 were compared for 733 patients whose data qualified for analysis.


RESULTS
At 1 and 5 years after treatment, 85-88% of patients had stable PSA <1.5 ng/mL. Biopsies were negative in 90-94% at 2 years.


CONCLUSIONS
The modification in techniques provides positive results that remain stable over time.
Sharkey
J
J
Urology Health Center, New Port Richey, Florida, USA.
Chovnick
S D
SD
Behar
R J
RJ
Perez
R
R
Otheguy
J
J
Rabinowitz
R
R
Solc
Z
Z
Huff
W
W
Cantor
A
A
Steele
J
J
Webster
C
C
Donohue
M
M
D000230:Adenocarcinoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005069:Evaluation Studies as Topic; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D009367:Neoplasm Staging; D010165:Palladium / Q000627:therapeutic use*; D010502:Perineum / Q000000981:diagnostic imaging; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen