Permanent interstitial brachytherapy for the management of carcinoma of the prostate gland.
OBJECTIVE
We summarize the permanent prostate brachytherapy literature, including biochemical outcomes, quality of life parameters and areas of controversy.


METHODS
The permanent prostate brachytherapy literature was reviewed using MEDLINE searches to ensure completeness.


RESULTS
Using various planning and intraoperative techniques the majority of the brachytherapy literature demonstrates durable biochemical outcomes for patients with low, intermediate and high risk features. For low risk patients there is no advantage to combining supplemental external beam radiation therapy with brachytherapy. In addition, supplemental external beam radiation therapy may not improve biochemical outcomes for patients at intermediate and high risk if the target volume consists of the prostate with a generous periprostatic margin. There is no defined role for adjuvant hormonal manipulation. Although a reliable set of pretreatment criteria to predict implant related morbidity is not available, severe urinary and rectal morbidity is rare. The incidence of brachytherapy induced erectile dysfunction is significantly greater than initially reported but the majority of patients respond favorably to sildenafil.


CONCLUSIONS
Continued refinements in brachytherapy planning and implementation techniques, postimplantation evaluation and continued elucidation of the etiology of urinary, bowel and sexual dysfunction should result in further improvements in biochemical and quality of life outcomes.
Merrick
Gregory S
GS
Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia, USA.
Wallner
Kent E
KE
Butler
Wayne M
WM
D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy*; D013997:Time Factors
D006728:Hormones; D017430:Prostate-Specific Antigen