Transperineal 125iodine implantation for treatment of clinically localized prostate cancer:: 5-year tumor control and morbidity

Purpose: To evaluate the efficacy and toxicity of transperineal I-125 implants for clinically localized prostate cancer in elderly men in a community cancer setting. Methods and Materials: From 1988 to 1993, 206 patients, median age 77 years, with localized (Stage T1 and T2), low-grade (Gleason score less than or equal to 7) prostate cancer were treated using pre-planned I-125 transperineal implants. Patients were followed for biochemical freedom from disease, overall survival, and treatment-associated morbidity. Results: The 5-year actuarial biochemical freedom from failure rate for all patients available for follow-up was 63%. Specifically, biochemical freedom from failure was 76% in patients with pretreatment PSA less than or equal to 10 ng/ml, compared to 51% of patients with values > 10 ng/ml (median observation time 35 months). Actuarial freedom from failure for patients with PSA less than or equal to 4 ng/ml was 84%. Stage and Gleason score did not predict outcome. PSA nadir was the strongest predictor of long-term biochemical disease-free survival (p < 0.001) with only 2 failures in 62 patients who achieved a posttreatment PSA nadir less than or equal to 0.5 ng/ml. Conclusion: Transperineal 125I implants for early prostate cancer are efficacious and feasible for certain populations of elderly patients with favorable prognostic indicators in the community canter setting. Patients with poor prognostic indicators at diagnosis do not appear to be candidates for treatment with implant alone. (C) 1999 Elsevier Science Inc.