Prostate cancer with large glands treated with 3-dimensional computerized tomography guided pararectal brachytherapy: up to 8 years of followup.
OBJECTIVE
We report post-brachytherapy results in patients with cancer in a large prostate.


METHODS
From June 1, 1994 to June 30, 2000, 331 consecutive patients with a large prostate of 50 to 180 cm.3 (median 69) were treated with 3-dimensional computerized tomography guided brachytherapy. Patient age was 42 to 90 years (median 69). Of these patients 327 were available for followup for 2 to 8 years (median 4.5). Patients were stratified according to risk profile. The high risk group had 1 or more high risk factors (prostate specific antigen [PSA] greater than 20 ng./ml., Gleason greater than 7, stage T2b, T3a or T3b) or 2 intermediate risk factors (PSA 10 to 20 ng./ml. and Gleason 7). The high risk group was further stratified into subgroups with a similar risk profile. The intermediate risk group had only 1 high risk factor (PSA 10 to 20 ng./ml. or Gleason 7). The low risk group had PSA less than 10 ng./ml., Gleason less than 7 and stage T1a, b, c or T2a. A dose of 144 Gy. with 125I or 120 Gy. with 103Pd was achieved in 90% to 100% of the target. A total of 31 patients (9%) had previously undergone transurethral resection and 198 (60%) were treated with 3 months of neoadjuvant androgen ablation.


RESULTS
Biochemical disease-free survival was achieved in 90% of the 182 patients at high risk, 96% of the 52 at intermediate risk and 99% of the 93 at low risk. Seven patients (2%) required catheterization during year 1 for urinary retention, 11 (3%) required transurethral prostate resection 1 to 4 years after implantation, 3 patients (1%) had grade 1 or 2 incontinence after repeat transurethral prostate resection and 4 (1%) had grade 3 or 4 rectal complications.


CONCLUSIONS
The 3-dimensional computerized tomography guided pararectal permanent implant results in a high level of biochemical control with low morbidity at 2 to 8 years in patients with prostate cancer who have a large prostate. There was less favorable biochemical control in patients with PSA greater than 20 ng./ml., Gleason 7 or greater and seminal vesicle invasion.
Koutrouvelis
Panos G
PG
Uro-Radiology Prostate Institute, Vienna, Austria.
Lailas
Niko
N
Katz
Stuart
S
Sehn
James
J
Gil-Montero
Guillermo
G
Khawand
Nabil
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020728:Transurethral Resection of Prostate
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen