PROSTATE-SPECIFIC ANTIGEN BASED DISEASE-CONTROL FOLLOWING ULTRASOUND-GUIDED (125)IODINE IMPLANTATION FOR STAGE T1 T2 PROSTATIC-CARCINOMA/

Purpose: We report the prostate specific antigen (PSA) based recurrenc e-free survival rate after (125)iodine (I-125) implantation for early stage prostatic carcinoma. Materials and Methods: A total of 197 patie nts with clinical stage T1 or T2 prostatic carcinoma underwent outpati ent I-125 Seed implantation. Followup was I to ? years (median 3), Pre treatment serum PSA levels were elevated (greater than 4,0 ng./ml.) in 138 patients (70%). There were 105 well differentiated (Gleason score 2 to 4), 87 moderately differentiated (Gleason score 5 to 6) and 5 in determinate tumors. The prescribed minimum prostatic dose was 160 Gy. The total dosage of I-125 implanted ranged from 15 to 62 mCi. (median 37). Staging lymph node dissection and seminal vesicle biopsies were n ot routinely performed. Results: Among 138 patients with an elevated P SA level before implantation and no prior hormonal treatment, the PSA value returned to normal in 98% and decreased to less than 1.0 ng./ml. in 82% within 24 months of treatment. In 97% of those 138 patients th e PSA level decreased to less than 1,0 ng./ml. at 48 months after impl antation. Of 8 patients with an increasing PSA value 5 also had clinic ally evident failure, The actuarial rate of chemical (increasing PSA) or clinical failure at 5 years following implantation was 7%, with 15 patients still at risk at 5 years. There was a trend for higher failur e rates among patients with higher pretreatment PSA levels (p = 0.57), Gleason scores 5 and 6 versus 2 to 4 (p = 0.51) or higher stage of di sease (p = 0.17). Conclusions: There is a high rate of clinical and ch emical freedom from progression following I-125 implantation for selec t patients with early stage prostatic carcinoma.