Transperineal permanent seed implantation of "low-risk" prostate cancer: 5-year-experiences in 118 patients.
OBJECTIVE
To evaluate 5-year prostate-specific antigen (PSA) relapse-free survival of transperineal permanent seed implantation (TPSI) in 118 patients with "low-risk" prostate cancer, that means stage cT1c-T2a, Gleason Score < 7, and initial PSA value < 10 ng/ml.


METHODS
From 04/1999 to 06/2002, a total of 118 patients underwent a mono-TPSI, using ultrasound-based preplanning and intraoperative verification by both ultrasound and conventional fluoroscopy as well as postoperative CT planning. Patients were monitored during the 1st year in 3-month intervals, and in 6-monthly intervals from then onward. Biochemical failure was defined according to ASTRO criteria with three consecutive PSA rises observed from a posttreatment nadir PSA value. The median follow-up was 48.9 months (range: 37.0-80.2 months). 114 patients were eligible, four patients were lost to follow-up.


RESULTS
For the entire group, PSA relapse-free survival at 5 years was 94.7%, with six patients (5.3%) having a PSA relapse between 8 and 20 months after implantation. In the bNED patients (no biochemical evidence of disease), PSA values were < 0.2 ng/ml in 82.5% (94/114 patients), < 0.5 ng/ml in 13.2% (15/114 patients), < 1.0 ng/ml in 2.6% (3/114 patients), and < 1.5 ng/ml in 1.7% (2/114 patients). In summary, PSA values < 0.2 ng/ml, < 0.5 ng/ml and < 1.0 ng/ml occurred in 82.5%, 95.7% and 98.3%, respectively. Out of the six patients with recurrent disease, three had a local tumor recurrence only, and three developed distant metastases.


CONCLUSIONS
In low-risk prostate cancer patients, TPSI with intraoperative ultrasound-based treatment planning and fluoroscopy leads to excellent local tumor control and PSA relapse-free survival.
Block
Thomas
T
Urologic Practice Vaterstetten, Bahnhofstrasse 36, 85591 Vaterstetten, Germany. urologie-vaterstetten@t-online.de
Czempiel
Heinz
H
Zimmermann
Frank
F
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen