[I125 low dose rate brachytherapy in localized prostate cancer. Preliminary results after 5 years]

Prostatic brachytherapy by permanent implant of I125 or Pd103 is a therapeutic option in the treatment of organ confined prostate cancer We analyze preliminary results and complications after five years in the group of patients who received I125 low dose rate brachytherapy as the only intention-to-cure treatment and evaluate the differences with the standard treatment (surgery).

From a case series of more than 400 patients treated with brachytherapy as radical intention-to-cure monotherapy for organ-confined prostate cancer we excluded patients with less than 12 months of follow-up for statistical analysis; the study group includes 275 patients enrolled between april 1999 and December 2003. Mean follow-up is 31 months (12-68). Biochemical failure was defined in accordance to the ASTRO criteria. Statistical survival analysis was carried out with the SPSS statistical software using the Kaplan Meyer method. Urinary and gastrointestinal complications were evaluated in accordance to the RTOG criteria.

Mean age was 68 years (range 49-83 years). 93% of the patients presented a clinical stage < or ='3dT2a and 7% T2b, with 60 8% of the cases having a PSA < or ='3d 10 ng/ml. Gleason score was < or ='3d 6 in 94% of the cases. 9% of the cases had a prostate volume > 50 cc. Overall 5 year survival was 96%, with a 97% disease-free survival and a 99% biochemical failure-free survival. Figure 3 and tables II-VI summarize the complications in various series including this.

Multiple published series seem to show similar results on biochemical control of the disease when comparing surgery and low dose rate brachytherapy in organ-confined disease. In comparison to surgery, brachytherapy has the advantage of having a lower percentage of immediate postoperative complications, lower incontinence rate, and a higher number of patients preserving erectile function.