Introduction:
In the past, radical prostatectomy (RP) and external beam radiotherapy (EBRT) – with or without hormonal therapy – has been the treatment strategies of choice for all locally confined prostate cancer patients. This was due to the fact that initial data on brachytherapy have been suboptimal. Meanwhile, permanent transperineal interstitial brachytherapy has become a competitive therapeutic option for patients with „low risk“ prostate cancer (cT1-2 Gleason Score <7 iPSA <10 ng/ml). Concerning biochemical evidence of disease (bNED) these treatment modalities supposed to be equieffective, although randomized clinical trials are still lacking [7,10,11,13,22,26,29]. The resurgence of interest in TPSI was a result of several technological advances, especially evolution in transrectal sonography and sophisticated treatment planning computer software. The accuracy of seed placement was significantly improved due to imaging and planning advances. Furthermore, computer tomography (CT)-based dosimetry after TPSI increases treatment quality and proactively predict outcome and complication [16]. Excellent TPSI results were obtained using a variety of planning and implantation techniques, with no method being proven superior.
In principle, TPSI can be performed in patients with low, intermediate and high risk prostate cancer. A mono TPSI is not recommended in intermediate and high risk prostate cancer, achieving bNED of less than 60 % in subgroups. Therefore, this study evaluated only patients with “low risk” prostate cancer who underwent TPSI [2,14,30].
Material and methods:
Patients: Between 04/99 and 06/02, 118 patient underwent TPSI in an interdisciplinary approach for low risk adenocarcinoma of the prostate. The median age of the total cohort was 65.1 (52.3-77.5) years. 114 patients were closely monitored and eligible. 4 patients were lost during follow up. The median follow up was 48.9 (37.0-80.2) months.
The prostate cancer was clinically staged by medical history, a physical examination including digital rectal examination, and serum PSA determination. A sceleton scintigraphy was obtained if the patient had clinical symptoms suspicious for bone metastases. Transrectal ultrasound was used for staging and biopsy guidance as well.
All patients had a low risk prostate cancer with PSA-values not beyond 10 ng/ml, Gleason score below 7 and tumour stage not beyond cT2a (Tab. 1).
T-Stadium:
cT1c:
cT2a: |
78 (66.1%)
40 (33.9%) |
Combined Gleason Score:
<5:
5:
6: |
31 (26.3%)
32 (27.1%)
55 (46.6%) |
Initiale PSA (ng/ml):
0-4:
4-10: |
12 ( 10.2%)
112 (89.8%) |
Neoadjuvant androgendeprivation therapy |
69 (58.5%) |
b. 1: Characteristics of patients (n=118)
69 patients (58.5%) underwent a 3-6 monthly neoadjuvant androgen deprivation therapy, mainly introduced by transferring urologists to overcome delayed treatment decisions. No patient received an adjuvant androgen deprivation treatment. No supplemental EBRT was given.
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