[Permanent implant prostate cancer brachytherapy: 2013 state-of-the art]

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Permanent implant brachytherapy with iodine 125 seeds has over 25 years of pioneering experience.
• It is recognized as a valuable alternative for localized low-risk prostate cancer.
• Studies confirm its extension to selected intermediate-risk patients.

Purpose of the Study:

• To evaluate the efficacy and safety of permanent implant brachytherapy for prostate cancer.
• To explore its role as an adjunct to external radiotherapy for dose escalation in higher-risk groups.
• To discuss evolving techniques and indications for brachytherapy.

Main Methods:

• Review of mid- and long-term results from available literature.
• Analysis of different permanent implant brachytherapy techniques (preplanning vs. real-time, seed types, delivery methods).
• Assessment of adherence to redefined dosimetric constraints by international societies like GEC-ESTRO.

Main Results:

• Relapse-free survival rates of approximately 90% at 5-10 years are reported, correlating with satisfactory dosimetry.
• Incontinence and impotence rates appear significantly lower compared to surgery.
• A 3-5% risk of urinary retention and irritative urinary syndrome are noted, potentially impacting quality of life.

Conclusions:

• Permanent implant prostate brachytherapy offers excellent long-term outcomes with favorable side effect profiles.
• Its indications are expanding, including focal brachytherapy and salvage therapy.
• The procedure requires mastery and adherence to dosimetric constraints for optimal results.