BRACHYTHERAPY IN PROSTATIC ADENOCARCINOMA

Brachytherapy can represent the exclusive treatment of localized prost atic adenocarcinoma. Several techniques have been described: permanent implantations with 125-iodine or 198-gold seeds or temporary implanta tions with 192-iridium. These implantations are performed either via a retropubic approach, often combined with pelvic lymphadenectomy, or v ia a transperineal approach, with or without ultrasound guidance. The largest clinical experience is from Memorial Sloan-Kettering Cancer Ce nter, with 1119 patients treated from 1970 to 1985 for stage B or C pr ostatic adenocarcinoma with pelvic lymph node dissection and interstit ial iodine-125 brachytherapy. The 15-year overall local control is 51 %. One of the strongest prognostic factors is lymph node involvement. The comparison between brachytherapy and other treatment modalities su ch as radical prostatectomy or external irradiation or even expectant management in localized tumors has never been performed prospectively, This type of randomized trial appears to be necessary in the assessme nt of the results published with brachytherapy.