Brachytherapy for clinically localized prostate cancer: results at 7- and 8-year follow-up.

Current issues in techniques of prostate brachytherapy.

The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy.

Quality of life after permanent prostate implant.

Prostate brachytherapy in patients with inflammatory bowel disease. (Grann, Wallner)

AU - Ragde H; Blasko JC; Grimm PD; Kenny GM; Sylvester J; Hoak DC; Cavanagh W; Landin K

TI - Brachytherapy for clinically localized prostate cancer: results at 7- and 8-year follow-up.

SO - Semin Surg Oncol 1997;13(6):438-43

AD - Northwest Hospital, Seattle, Washington, USA.
AB - In recent years, there has been a resurgence of interest in
interstitial radiation as a cost-effective and efficient method of
treating organ-confined prostate cancer. We describe our 7- and
8-year results with transperineal Iodine-125 and Palladium-103
implantation. A total of 551 consecutive patients were treated. Of
these, 320/551 (58%) received implant alone (Group I), and 231/551
(42%)--considered higher risk patients--were also treated with a
modest dose (45 Gy) of external beam irradiation (Group II). The
median follow-up for Group I was 55 months, and for Group II, 60
months. At 7 years, the actuarial freedom from biochemical failure
(prostate-specific antigen (PSA) < or = 1.0 ng/mL) was 80% in Group I
patients, and, at 8 years, 65% in Group II patients. Morbidity was
minimal if patients had not undergone prior transurethral prostate
resections. The results indicate that interstitial radiation is a
valid treatment for clinically localized prostate cancer.

AU - Nori D; Moni J
TI - Current issues in techniques of prostate brachytherapy.
SO - Semin Surg Oncol 1997;13(6):444-53
AD - Department of Radiation Oncology, New York Hospital, Cornell Medical
Center, Flushing 11355, USA.
AB - Adenocarcinoma of the prostate is the most common malignancy
diagnosed among men in the United States today. Brachytherapy permits
conformal radiotherapy and dose escalation, and it offers the
convenience of a single-day outpatient procedure which is very
attractive to patients with a busy life-style. The reported potency
preservation rates with brachytherapy are superior to both external
beam radiation therapy (EBRT) and surgery. The older retropubic
techniques have been replaced by ultrasound or CT-guided transperine-
al techniques. Prostate brachytherapy may be temporary or permanent,
and the planning techniques for either approach are similar. This
review briefly discusses the advantages and limitations of each.
Temporary techniques may be used with low dose rate or high dose rate
applications. The basic steps include assessing prostate volume by
any diagnostic modality (CT or ultrasonography), determining total
activity needed to encompass the gland and deliver the appropriate
minimum peripheral dose, and determining the pattern of placement of
the seeds within the gland. Preplanning may be done either by
ultrasound or by CT. The operative technique requires the visualizat-
ion of the prostate in three dimensions and is performed using
combination of ultrasound and fluoroscopy or fluoroscopy in two axes.
The New York Hospital technique employs CT-based preplanning along
with ultrasound and fluoroscopy during the operative procedure.
Special circumstances that necessitate neoadjuvant hormonal therapy
include interference from the pubic arch and large volume glands. An
analysis of patients with stage T2a disease treated at the New York
Hospital-Queens, from 1990-1995, reveals an actuarial clinical
freedom from relapse of 79% at 5 years and a 5-year biochemical
freedom from relapse of 64% which is comparable to that reported for
similar risk groups of disease by other centers. Potency is preserved
in greater than 80% of patients in our series. Patient selection
criteria include the pre-treatment prostate-specific antigen (PSA)
level, tumor grade (Gleason), stage of disease, and presence or
absence of bilateral positive biopsies and/or perineural invasion.
Based on our review of the literature and our clinical results, we
have divided patients with prostate cancer into good, intermediate
and poor risk groups. We recommend brachytherapy as the sole
procedure for good risk patients, and a combination of external beam
radiation therapy (EBRT) and brachytherapy for the intermediate risk
group. Future avenues for research include a search for improved
imaging techniques and possibly newer isotopes. (46 Refs)

AU - Stock RG; Stone NN
TI - The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy.
SO - Semin Surg Oncol 1997;13(6):454-60
AD - Department of Radiation Oncology, Mount Sinai Medical Center, New York,
New York 10029, USA.
AB - The objectives of this study were to examine the effect of both
disease and treatment related prognostic factors on biochemical
control and post-treatment biopsy. Two-hundred fifty-eight patients
underwent interactive ultrasound guided transperineal prostate
implantation for T1-T2 prostate cancer using Iodine-125 (139
patients) and Palladium-103 (119 patients) and were followed from
6-67 months (median, 19). Hormonal therapy with 3 months of
leuprolide and flutamide prior to implantation and two months given
after the implant was used in 96 patients. Pre-treatment prostate-
specific antigen (PSA) had the most significant effect on biochemical
failure. Freedom from biochemical failure (FFBF) rates at 4 years
were 75% for patients with PSA 1.3-10 ng/ml (144), 74% for patients
with PSA 10.1-20 ng/ml (73), and 34% for patients with PSA > 20 ng/ml
(41) (P = 0.0004). Gleason score also had a significant effect on
FFBF rates. Four-year rates were 81%, 65% and 47% for patients with
scores of 2-4 (68), 5-6 (130), and > or = 7 respectively (60) (P =
0.01). These two factors were also significant in multivariate
analysis (P = 0.002, 0.007, respectively). Gleason score was the only
factor to significantly affect post-treatment biopsy results.
Patients with scores of 2-6 had 85% (63/ 74) negative 2-year biopsies
versus 62% (13/21) for patients with scores > or = 7 (P = 0.02).
Low-risk patients (PSA < or = 10 ng/ml, scores < 7 and stage < T2a)
had a 4-year FFBF rate of 88% as compared to 60% for high-risk
patients (PSA > 10 ng/ml, score > 6 or stage > or = T2b) (P = 0.02)
and had a 95% negative biopsy rate versus 76% for high-risk patients
(P = 0.06). Low-risk patients demonstrate high FFBF and negative
biopsy rates following implantation. Patients presenting with higher
risk prognostic factors such as PSA > 20 ng/ml or Gleason scores > or
= 7 may require more aggressive treatment regimens.

AU - Arterbery VE; Frazier A; Dalmia P; Siefer J; Lutz M; Porter A
TI - Quality of life after permanent prostate implant.
SO - Semin Surg Oncol 1997;13(6):461-4
AD - Department of Radiation Oncology, Wayne State University, Detroit,
Michigan, USA. arterber@kei.wayne.edu
AB - Quality of life is one of several endpoints commonly studied in
prostate cancer treatment. It refers to how well an individual is
functioning in life and his total sense of well being. There is
increasing recognition that cancer therapy impacts significantly on
the patient's ability to pursue relational, occupational and social
interests. Fifty-one patients with clinically localized prostate
cancer who had undergone transperineal permanent prostate implantati-
on were evaluated. All patients were clinically staged as T1c or T2a
and received an implant alone with Iodine 125 or Palladium 103 as
definitive treatment. Six months after implant, data was collected
using the European Organization for Research and Treatment of Cancer
(EORTC) genitourinary group questionnaire and supplemental questions.
Urinary symptoms such as nocturia, hesitancy, frequency, and dysuria
were the most pronounced in the first few months after the implant
and then decreased in most of patients; 40% noticed that they
urinated more frequently and 17% had mild dysuria. All patients
denied hematuria and none reported incontinence. Few patients
reported any psychological distress or disruption in social or family
life; none reported disruption in economic status or viability. All
fifty-one patients said that they would have an implant again as
definitive treatment. Seventy-nine percent reported an excellent
quality of life post-implant. While survival is clearly a central
goal of treatment for prostate cancer, the nature of this malignancy
compels clinical attention to the quality of the patient's life after
treatment. Sexual quality and function are maintained in the majority
of patients and there is minimal interruption of their social and
economic function.


Prostate brachytherapy in patients with inflammatory bowel disease.
Int J Radiat Oncol Biol Phys 1998;40(1):135-8

Grann A; Wallner K
Brachytherapy Service, Department of Radiation Oncology, Memorial
Sloan-Kettering Cancer Center, New York, NY 10021, USA.
PURPOSE: There are minimal data to support the perceived contraindic-
ation of radiation therapy in patients with inflammatory bowel
disease (IBD). Because of widespread concern about the possibility of
radiation-related morbidity in IBD patients, the posttreatment course
for 6 patients with a history of IBD who were treated with 125I
prostate implantation for early stage prostate cancer are reported
here. MATERIALS AND METHODS: Six patients with a prior history of IBD
and Stage T1c-T2c prostatic carcinoma underwent 125I prostate
brachytherapy from 1991-1996. Three patients had Crohn's disease and
three had ulcerative colitis. The treatment plans were designed to
treat the preimplant prostatic margin, as defined on planning CT
scan, to 150 Gy. No special effort was made to minimize the rectal
surface dose. Detailed records were available for all patients, and
all patients were interviewed for this report. Follow-up ranged from
1 to 6 years (median: 3.7 years). RESULTS: None of the 6 patients
experienced unusual or significant gastrointestinal side effects
following implantation. All 6 patients remain free of GI complicatio-
ns. The rectal surface area that received > 100 Gy was kept below 10
mm2 in all patients, in accordance with previously published
guidelines. CONCLUSIONS: Based on the limited information available,
it appears that prostate brachytherapy is safe in patients with a
history of IBD.