Minimally invasive treatment for localized adenocarcinoma of the prostate: Review of 1048 patients treated with ultrasound-guided palladium-103 brachytherapy

Purpose: To assess the effectiveness of palladium-103 brachytherapy in stage T-1 and T-2 adenocarcinoma of the prostate. Patients and Methods: The charts of 1048 patients treated between 1991 and 1999 with transperineal realtime ultrasound-guided Pd-103 (Theraseed(R)) implants were reviewed to assess the effects on serum prostate specific antigen (PSA) values and tissue (biopsy), Of the 1048 patients, 780 had sufficient data for this report. Preoperative total androgen blockade (leuprolide and flutamide) was used selectively in patients whose prostate size was >50 cc and those whose tumors had a Gleason score of >7, Results: At 1 year, 86% of the evaluable 766 patients had stable PSA concentration <1.5 ng/mL; at 5 years, 86% of the 166 patients with data available had stable PSA values <1.5 ng/mL. Biopsies were negative in 92% of the patients studied at 2 years. Patients with pretreatment PSA values <10 ng/mL had the best outcomes, and those treated with Pd-103 plus hormone ablation achieved PSA reduction more rapidly than those treated with radioisotope monotherapy, There was one disease-related death; the principal morbidity was short-term bladder and bowel irritation without permanent sequelae, Impotence occurred in approximately 15% of patients, and incontinence occurred in 5% of those who had undergone prior transurethral resection of the prostate. Conclusion: The technique used in this study proved effective in reducing PSA concentrations to <1.5 ng/mL and in producing negative biopsies 1 and 2 years postoperatively, These results are comparable to those of external-beam radiation therapy and radical prostatectomy while demonstrating a significant reduction in morbidity.