ACTUARIAL DISEASE-FREE SURVIVAL AFTER PROSTATE-CANCER BRACHYTHERAPY USING INTERACTIVE TECHNIQUES WITH BIPLANE ULTRASOUND AND FLUOROSCOPIC GUIDANCE

Purpose: To evaluate the effectiveness and safety of interactive trans perineal brachytherapy under biplane ultrasound and fluoroscopic guida nce in patients with localized prostate cancer. Methods and Materials: Brachytherapy using I-125 or Pd-103 radioactive seeds either alone or in combination with adjunctive external beam radiotherapy (XRT) was a dministered to 490 patients at a single institution. Posttreatment fol low-up included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels and documentation of treatment -related symptoms and complications. Results: Actuarial disease-free s urvival at 5 yr was 79% (95% CI, 71-85%), and the 5-yr actuarial rate of local control was 98% (95% CI, 94-99%). Post-treatment PSA nadir an d pretreatment PSA level were found to be significant predictors of di sease-free survival. In patients with a PSA nadir < 0.5 ng/ml, 5-yr di sease-free survival was 93% (95% CI, 84-97%), compared with 25% (95% C I, 5-53%) in patients whose PSA nadir was 0.5-1.0 ng/ml and 15% (95% C I, 3-38) in patients with a PSA nadir > 1.0 ng/ml. Brachytherapy was w ell tolerated with few post-treatment complications. Conclusion: A bro ad range of patients with localized prostate cancer can benefit from t ransperineal brachytherapy with minimal morbidity. A post-treatment PS A nadir below 0.5 ng/ml provides a useful prognostic indicator of favo rable long-term outcome. (C) 1998 Elsevier Science Inc.