Prostate brachytherapy: a three-year experience from the first 116 patients in Greece

To present the results from the first 116 patients with localized prostate cancer treated with transperineal ultrasonography-guided permanent brachytherapy, with special emphasis on the complications of this method.

During the last 3 years, 116 patients with localized prostate cancer underwent transperineal ultrasonography-guided permanent implantation with I(125) seeds. Permanent implantation consisted of 21-82 I(125) seeds of 0.529 mCi each, for a total implant dose of 145 Gy. The peripheral loading implant was used and a-blockers preimplantation were administered to most of our patients.The follow-up consisted of clinical examination and serum prostate specific antigen (PSA) estimation every 3 months. Three successive rises of PSA with a 3-month interval inbetween constituted a biochemical failure.

No patient was incontinent after treatment. Acute urinary retention was developed in 9 (7.7%) patients. During the first 3 months postimplantation approximately 55% of the patients complained of dysuria, urgency, frequency and nocturia, but their urinary complaints disappeared within one year postimplantion. Three (2.5%) patients developed mild proctitis. Sixty-seven percent of the potent patients remained potent at the end of the first year. Biochemical relapse appeared in 5 (4%) of the 116 patients studied.

It seems that prostate brachytherapy, a method that is well tolerated and safely administered, can be accomplished with minimal acute and chronic complications. Prostate size is a predictor for acute urinary retention and prophylactic use of a-blockers seems to reduce the incidence of postimplantion acute retention. Also, lower incidence of impotence was found in comparison with the incidence after radical prostatectomy.