Permanent brachytherapy: prostate seed implants as an out-patient treatment

Upto April 1999 interstitial seed implants were being performed throughout Europe only as an in-patient treatment. Consequently, we questioned whether this same method could be performed as an out-patient treatment without forfeiting the required quality and safety normally observed with in-patients. Since April 1999 we have treated 73 patients with iodine 125 seed implants (RAPID strand). The average patient age was 65 yrs, the average PSA was 11.5 ng/ml, tumor stage was either T1 or T2. All treatments were carried out in general anesthesia under ultrasound and flouroscopy monitoring. Pre- and post implant dosimetry was planned using the Variplan 6.7 computer program (former MMS). All patients tolerated the out-patient treatment very well. The average duration for anesthesia was 76 minutes, total time per patient spent in the center on implant day was 250 minutes. 54 patients were treated with a monotherapy 145 Gy, while 19 patients received external beam radiotherapy (45 Gy) plus the iodine seed boost (100 Gy). Almost 75% of the patients experienced some form of voiding discomfort during the 4-10th post implant week. In the CT post plan dosimetry performed 4 weeks after the implant, 95% of the patients obtained a good coverage of the prostate with the planned prescription dose. Iodine seed implants can be considered a safe out-patient form of treatment with a low complication and morbidity rate and a high standard of quality. The technical improvements in computer dosimetry software, modified application methods, constantly updated equipment and critical quality assessment has lead to improved overall long term results.