Short-term freedom from disease progression after I-125 prostate implantation

Int J Radiat Oncol Biol Phys. 1994 Sep 30;30(2):405-9. doi: 10.1016/0360-3016(94)90021-3.

Abstract

Purpose: To evaluate short-term clinical and chemical disease progression following computed tomography (CT)-based transperineal I-125 prostate implantation.

Methods and materials: Sixty-two patients with clinical Stage T1 or T2 prostatic carcinoma had outpatient, CT-based transperineal I-125 prostate implantation and have been followed for 6-55 months (median: 19 months). Fifty-six patients had an elevated prostate specific antigen (PSA) before implantation (> 4.0 ng/mL). Twenty patients had well-differentiated tumors, 39 were moderately differentiated, 2 were poorly differentiated, and 1 was indeterminate. A total of 32-73 mCi I-125 was implanted (median: 47 mCi). The prescribed minimum prostatic dose was 140-160 Gy, and the actual matched peripheral dose ranged from 109-258 Gy (median: 160 Gy). Lymph node dissection or postimplantation prostatic biopsies were not routinely performed.

Results: Of 54 patients with an elevated PSA prior to implantation and no prior hormonal treatment, 96% returned to normal within 24 months of treatment. In 85% of patients, the PSA fell below 2.0 ng/mL and in 74% of patients, the PSA value fell to below 1.0 ng/mL. Seven patients had disease progression, one of whom has an isolated, rising PSA. The actuarial rate of chemical (rising PSA) or clinical failure at 3 years following implantation was 17%. Of 38 patients who were sexually potent prior to implantation, 81% remained potent at 3 years. Five patients developed radiation-induced rectal ulcerations, 11-22 months following implantation. Three patients required a transurethral resection of the prostate for postimplant urinary symptoms.

Conclusions: The short-term clinical and chemical freedom-from-progression rates following I-125 implantation are comparable to that achieved with prostatectomy, with high preservation of sexual potency and moderate morbidity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brachytherapy*
  • Disease Progression
  • Humans
  • Iodine Radioisotopes / therapeutic use*
  • Male
  • Middle Aged
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / radiotherapy*
  • Radiotherapy Dosage

Substances

  • Iodine Radioisotopes
  • Prostate-Specific Antigen