Purpose: Implementation of permanent prostate implant (PPI) brachytherapy in Hungary and presentation of initial experience.
Patients and methods: Between December 2008 and 2010, thirty-nine patients with low (n=26) and intermediate (n=13) risk prostate cancer were treated with PPI. Their mean age and initial PSA were 66 year (51-80 year) and 9 ng/ml (3,2-15 ng/ml). Iodine-125 loose seeds were implanted under spinal anaesthesia using the FIRST system (Nucletron, The Netherlands). Needles were inserted into the prostate through the perineum according to the preplan based on transrectal ultrasound images. The treatment plan was modified according to updated positions of the needles on live US images. The prescribed dose to the prostate was 145 Gy. Seed loading was performed under real-time US assistance. Implanted sources were checked by X-ray and CT images. Patients were discharged one day after the implantation. On follow-up visits PSA and toxicity were registered.
Results: The mean follow-up was 10 months (3-27 months), the median number of seeds was 53 (30-78), their mean activity was 0.48 mCi (0.41-0.52 mCi). The mean coverage of the prostate by the prescribed dose was 96% (92-98%). The mean percent dose of the prescribed dose that covered the 90% of the prostate (D90), 2 cm3 of the rectum (Dr2cm3) and 10% of the urethra (Du10) were 113% (104-121%), 85% (48-121%) and 124% (98-146%) respectively. Deviation from the requested dose-volume constraints never exceeded 3%. Acute >grade 2 proctitis, grade 2 and 3 cysto-prostatitis were observed in 0 (0%), 13 (33.3%) and 1 (2.6%) cases. Biochemical relapse occurred in one patient (2.6%).
Conclusion: This is a report of the first application of PPI in Hungary. The observed rate of acute proctitis was negligible, the rate and severity of acute cysto-prostatitis was tolerable. With the use of intraoperative planning, dose distributions met the dose-volume constraints in most of the cases. The biochemical control is excellent but the follow-up time is still short.