Permanent Interstitial Brachytherapy in the Treatment of Localized Prostatic Carcinoma: The Piedmont Experience

Abstract

The modern interstitial brachytherapy plays a first-rate role in the treatment of the organ-confined prostatic carcinoma as a substantial alternative to radical prostatectomy and external beam radiotherapy in selected patients. Materials and Methods In our Centre 50 patients with a localized prostatic carcinoma were treated with transperineal and transrectal ultrasound-guided permanent implantation of I-125 radioactive seeds. 35 patients also underwent a neoadjuvant hormonal-therapy. Main end points were the biochemical control of the neoplasia and the treatment complications during a 24 months follow-up. Results We had two biochemical neoplasia recurrences, both in the neoadjuvant group. The most frequently observed complications were: slight irritative symptoms (12%), severe irritative symptoms (30%), urinary retention (10%), hematuria (8%), loss of seeds (6%), erectile dysfunction (46%). Urinary incontinence, urethral stricture and proctitis were not observed. Conclusions So far no large clinical trial compared the clinical efficacy of interstitial brachytherapy versus the other “conventional” treatments options (radical prostatectomy, external beam radiotherapy). The results of our study and the actual evidences, based on cohort observation studies and case-control ones comparing brachytherapy versus surgery or external irradiation, support the therapeutical value of permanent interstitial implant with regard to oncological results and complications.