COMBINED HDR-BRACHY- TELETHERAPY IN LOCAL IZED PROSTATE-CANCER - A REPORT ON 158 PATIENTS/

Since 1986, 158 patients with localized prostatic carcinoma have been subjected to combined HDR-brachy-/teletherapy at the Departments of Ur ology and Radiooncology of the University of Kiel. Tumour staging by t ransrectal ultrasound was T1 b in 2, T2 in 105 and T3 in 51 cases. Tum or grading distribution was as follows: 26 G1, 79 GZ and 53 G3/G4 tumo urs. 40% of the patients had an initial serum PSA level of more than 2 0 ng/ml (Hybritech). The follow-up period lasted between 1 and 102 mon ths and averaged 47 months with a median of 49 months. 8 patients died of the cancer and 15 others of intercurrent diseases. 18 patients sho wed clinical progression, of these 12 systemic, 5 local and 1 both sys temic and local. A further 16 patients showed a PSA increase but no cl inical progression. In terms of tumour staging, 20 of 107 patients wit h localized tumuor involvement (T1/T2), and 14 of 51 with more extensi ve involvement (T3), developed clinical or biochemical progression. Tu mour grading revealed an even more pronounced difference: clinical or biochemical progression was seen in 4 of 26 highly differentiated tumo urs, 9 of 79 moderately differentiated tumours and, notably, 21 of 53 poorly differentiated or undifferentiated tumours. Among longterm side effects persisting for over a year or with onset at least 1 year after therapy, there were 26 cases of proctitis/colitis and 19 cases of dys uria/radiogenic cystitis. With regard to the large number of patients with an initially high serum PSA level (> 20 ng/ml) and the high rate of T3-tumours, combined HDR-brachy-/teletherapy proved to be an effect ive treatment of localized prostatic carcinoma.