title: [Prostate brachytherapy: oncological and functional results after 400 cases].
abstract: BACKGROUND
  Brachytherapy (BT) with real-time technique for the treatment of low and medium risk prostate cancer (CaP) has been a well known practice for over 25 years in the USA and for over  15 years in Italy. However, it is an uncommon procedure, because of problems related to the organization and cooperation among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique.
  
  
  METHODS
  Between May1999 and July 2013, 400 patients with low and medium risk CaP underwent I 125 BT using a "real-time" approach. The seeds implantation was performed using a Mick applicator in the first 190 patients and the "QuickLink" technique in the last 210 cases. Oncologic results were reported for the first 250 cases with a mean follow-up of 10 years, while functional outcomes and complications were assessed in 350 patients with a minimum follow-up of 1 year.
  
  
  RESULTS
  A good quality implantation was assessed in 90% of the patients (D90>145 Gy). A biochemical failure was assessed, based on Phoenix criteria, in 12 patients (4.8%). Out of these patients,  10 underwent prostate biopsy (the other 2 patients showed a systemic disease). The biopsy showed a CaP in 6/10 patients who underwent retropubic radical prostatectomy (4 patients) and external radiotherapy (2 patients) respectively. The remaining 4/10 patients with negative biopsy were treated with total androgen blockade (3 patients) and watchful waiting (1 patient) respectively. Functional results showed an incidence of postoperative irritative disorders in 70% of the patients during the first six months and a good recovery of erectile function in 78.8% and 68.2% of the patients after one and five years from BT respectively.
  
  
  CONCLUSIONS
  Brachytherapy is a good alternative to radical prostatectomy in the low and medium risk prostatic cancers with excellent oncologic and functional results.
authors.affiliation: Dipartimento di Chirurgia, S.C. Urologia, Ospedale San Paolo, Savona - Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Gastaldi
authors.forename: Luciano
authors.initials: L
authors.lastname: Chiono
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gallo
authors.forename: Claudio
authors.initials: C
authors.lastname: Giberti
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy / Q000295:instrumentation; D003131:Combined Modality Therapy; D003199:Computer Systems; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen