Brachytherapy with permanent seed implantation

Permanent interstitial brachytherapy with iodine-125 (I-125) or palladium 103 (Pd-103) seeds is a common treatment option in the United States, and numerous articles on outcomes after long-term follow up have been published. With the treatment's apparent high efficacy and low morbidity, permanent seed implantation has become the most frequently employed procedure for localized prostate cancer and has replaced radical prostatectomy. Even taking into account the good features of the treatment, the performance of permanent seed implantation in Japan had not been allowed because of the country's strict laws on radiation safety. However, after a long period of discussion between Japanese medical associations and the government, permanent interstitial brachytherapy with I-125 was finally approved in Japan in July 2003. The guidelines for this treatment include several restrictions that should be followed by each institution that is to perform the treatment. Over 70 institutes around the country had started the treatment before the end of June 2007. With high expectations for this new radiation therapy, which may be effective, and less invasive than previous treatments and with a low incidence of treatment morbidity, brachytherapy for prostate cancer will become more common in Japan. For the purpose of improving the quality of seed implantation, which may lead to better clinical outcomes and radiation safety, medical conferences and technical training courses have been carried out regularly, and multi-institutional clinical studies have also been carried out countrywide.