Prostate I 125 Brachytherapy: Critical Evaluation of Mid Term Oncologic and Functional Results after 250 Cases

Abstract

Even if brachytherapy (BT) in low-risk prostate cancer (CaP) is a common practice since more than 20 and 10 years in U.S.A. and Italy, respectively, it is still an uncommon procedure because of the problems related to the organization and collaboration among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique. Between May 1999 and September 2010, 250 patients with low risk CaP underwent I125BT using a "real time" approach; the seeds implantation was performed using Mick applicator, in the first 190 patients, and the "Quick-Link" technique in the last 60 cases. Oncologic results were reported in the first 150 cases with a mean follow-up of 95 months, while functional outcomes and complications were assessed in all the patients at different time points with a mean follow-up of 65 months. A good quality implantation was assessed in 88% of patients (D90 >140 Gy). Overall, a biochemical failure was assessed, in accordance with Phoenix criteria, in 10 patients (6.6%). Among these patients, the prostatic biopsy showed a CaP in 6/10 patients, who underwent retropubic radical prostatectomy (4 pts) and external RT (2 pts); only one patient developed a systemic progression with secondary bone lesions and died after 122 months and 36 months from BT and RRP, respectively. The 4/10 patients with negative biopsy were treated with total androgen blockade (2 pts) and with watchful waiting (2 pts). Regarding functional results, we assessed a moderate incidence of irritative disorders (70%) during the first six months and a good recovery of erectile function after one year from surgery (78.8%). Brachytherapy in the low-grade risk prostatic cancer represents a good alternative to RRP with excellent functional and oncologic results