I-125 implantation for localized prostate cancer: the Utrecht University experience

Background and purpose: I-125 seed implantation is one of the treatment modalities for localized prostate carcinoma. It has few side effects compared with radical prostatectomy and beam irradiation. Materials and methods: At the University Medical Centre, Utrecht, 249 naive patients were treated by perineal implantation between December 1989 and December 1998. Mean age was 69 years (range 45-91 years). Stage and grade were: T-1, 121; T-2, 126; T-3, 2; well differentiated, 136; moderate, 100; undifferentiated, 15; not established, 8. Mean initial PSA level was 16.1 ng/ml (range <1.0-165). Mean prostate volume was 33 cm(3). Sixty-two patients had had previous surgical intervention for voiding problems. Treatment evolved from single seeds to RAPID Strand, and from a probe-mounted template to stepping unit and pre-planning. The introduction of RAPID Strand considerably increased the number of seeds (mean 41- > 65 seeds). Mean follow-up was 32.8 months, median 29.2 months (range 6-94 months). Results: A total of 195 patients had no evidence of disease (18 died of intercurrent causes) and 54 had evidence of disease (13 died with prostate cancer). Toxicity was found in 22 patients. Urinary side-effects occurred in 18 patients, in nine cases after previous TURF. Four patients had intestinal problems, but only one had a rectal ulcer, which healed after hormonal therapy for local recurrence. Conclusions: Our findings indicate a correlation between the number of seeds implanted per cm(3) prostate volume and the final result. This is also reflected in a better volume coverage from MRI studies. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.