Brachytherapy with transperineal (125)Iodine seeds for localized prostate cancer

Background and purpose: To analyze the treatment results of transperineal ( 125)Iodine seeds in localized prostate cancer. Patients and methods: Between 1985 and 1996, 102 patients with T1-T2 NO pro state cancer were treated with transperineal (125)Iodine seed implants at t he Academic Medical Centre in Amsterdam. Tumours were classified as T1c in four patients, T2a in 73 patients and T2b in 25 patients. The mean pre-trea tment PSA was 17 ng/ml. The (125)Iodine seeds were implanted transperineall y under transrectal ultrasound guidance. The mean prostate volume was 31 ml (range 15-48 ml). An average of 49 seeds (range 29-74) was implanted. The dose to the periphery of the prostate was 160 Gy. Until 1988, 27 patients h ad additional external pelvic irradiation to a dose of 40 Gy in 20 daily fr actions of 2 Gy. Results: The 5- and 7-year actuarial survival rates were 77 and 63%, respec tively (median 102 months). Ten patients (9.5%) died from prostate cancer. The 5- and 7-year clinical progression rates were 12 and 17%, respectively. Biochemical failure rates at 5 and 7 years were 39 and 44%, respectively. Age, alkaline phosphatase, creatinine, differentiation grade, additional tr eatment, staging procedure, number of seeds, prostate volume, treatment per iod and PSA were analyzed as prognostic factors. Only pre-treatment PSA was a prognosticator of clinical and biochemical outcome but not of survival. Biochemical control at 6 years varied from 30% for pre-treatment PSA values higher than 20 ng/ml to 95% for values less than or equal to 8 ng/ml. Fort y-one out of 49 patients who were sexually active before brachytherapy main tained sexual function during the follow-up. Complete urinary incontinence occurred in one patient. No rectal complications were seen in patients rece iving brachytherapy alone. Conclusions: Transperineal (125)Iodine seeds brachytherapy in localized pro state cancer achieves a good clinical control and overall survival with acc eptable late toxicity. Biochemical failure was strongly correlated to the p re-treatment PSA value. (C) 2000 Elsevier Science Ireland Ltd. All rights r eserved.