Palladium-103 brachytherapy for prostate carcinoma

Purpose: A report of biochemical outcomes for patients treated with palladi um-103 (Pd-103) brachytherapy over a fixed time interval. Methods and Materials: Two hundred thirty patients with clinical stage T1-T 2 prostate cancer were treated with Pd-103 brachytherapy and followed with prostate-specific antigen (PSA) determinations. Kaplan-Meier estimates of b iochemical failure on the basis of two consecutive elevations of PSA were u tilized. Multivariate risk groups were constructed. Aggregate PSA response by time interval was assessed. Results: The overall biochemical control rate achieved at 9 years was 83.5% . Failures were local 3.0%; distant 6.1%; PSA progression only 4.3%. Signif icant risk factors contributing to failure were serum PSA greater than 10 n g/ml and Gleason sum of 7 or greater, Five-year biochemical control for tho se exhibiting neither risk factor was 94%; one risk factor, 82%; both risk factors, 65%. When all 1354 PSA determinations obtained for this cohort wer e considered, the patients with a proportion of PSAs less than or equal to 0.5 ng/ml continued to increase until at least 48 months post-therapy. Thes e data conformed to a median PSA half-life of 96.2 days. Conclusions: Prostate brachytherapy with Pd-103 achieves a high rate of bio chemical and clinical control in patients with clinically organ-confined di sease. PSA response following brachytherapy with low-dose-rate isotopes is protracted. (C) 2000 Elsevier Science Inc.