THE USE OF ULTRASOUND-GUIDED TMNSPERINEAL IMPLANTATION OF 1125 & Pd103 FOR THE TREATMENT OF EARLY STAGE PROSTATE CANCER

Abstract

Introduction Titis study conducted bet\\'cCn July. 1996 and J_wte, 1999: 51 patients wtdersent TRUS guided prostate brachythcrapy The ailll ''as to determine the efftcacy of brachytherapy in cancer control as wc!l as evaluate associated side effects. Methods The average age of patients at the time of the implant was 66 years (50-79 years). Patients• clinical stage were Tlc (34 patients), T2a (13 patients) and T2b (4 patients) with a PSA ranging from 1.9 ng/ml to 19 ng/ml. Tite average size of the prostate gland prior to the implant in our studv was 33.5 cc. The maximwn volwne was 49.9 cc. Eleven patients received combined androge1blockade and 9 patients recei,-ed LHRH agonist only. 33 patients had 125I implant versus 18 \\ith 1 3 Pd implants based on Gleason sum aboYe 7. Three patients in our study were treated \\ith supplemental EBRT. Patients were discharged on the same day ''ith antibiotics. alpha-blockers, non-steroidal anti-i.n.flamm<ltory agents. FollO\v up included PSA, first at 6-8 weeks then at 3 month intervals for 2 years thm bi-annualy thereafter. Chest x-rays w•ere obtained in the immediate postoperative period to check for seed displacement. CT scmuting & dosimetry were obtained to detemtine the adequate co,•erage and to assess the quality of the implant. Results Forty-one patients \\ith an a\•crage PSA of 7. 7 ng/m.l were a success. These patients achieving a nadir PSA equal to or less than I ng/ml. 31 patients achieved a PSA nadir of less than• 0 5 ng/ml. Four patients were considered borderline outcome because their PSA never achieved nadir below I ng/m..l. Six patients were considered failures because their PSA started to rise after an ittitiul drop. All putients were continent except 2 patients had occasional dribbling. Weak stream was reported in 15 patients and 4 patients had retention postoperative. One patient required clean intennittent catheteriztion for 6 months before bladder flll1ction gradually recovered. Painful urination, reported by 3 patients, was mild and required no treatment. Mild urgency was reported in I I patients. Nochlfia reported in 12 patients was usually mild (l-2) except in 3 patients (4-5). Frequency was reported in 5 patients. At! these symptoms resolved spontaneously. Potency was adequate for intercourse in 38 patients. erections were inadequate for intercourse in 6 patients. 3 patients were impotent and 4 patients were not evaluated for potency. Rectal complications "ere ntild and required medication in only one patient. Other complication included fe,•er reported by one patient and 3 patients were fowtd to have seed migration to the lungs. None of them dc\"cloped any adYcrsc events as a result. Conclusion 0Lif results showed the tcclmique is effective and comparable ,vith other currently available methods of prostate cancer management. Side effects were both acceptable and tolerable.