Local control after brachytherapy for localized prostatic carcinomas

From 1991 to 1995; 31 patients (mid-age: 70 years) underwent prostatic brachytherapy for localized prostate cancers using Iridium 192 transperineal percutaneous interstitial implantation guided by transrectal ultrasonography. Initial staging included among other evaluations a bilateral staging, iliac and obturator lymph nodes dissection. Classification according to stage was : T1b=16%, T1c=36%, T2a=19%, T2b=13%, T2c=13%, T3a=3%. All patients were N (-). Gleason score was < 5 for 45% of the patients and > 5 for 55%. 77% of the initial PSA was < 25μg/l. Follow-up included one clinical control and psa determination at 1-3-6-12 and 18 months, bone scanning at 12 months and prostate biopsy guided by transrectal ultrasonography at 18, 24, 30 months. Up to now, mean follow-up is 32 months. At one month, psa was normal (< 2,5μg/l) in 21% of the patients, at 12 months 60% and 67% two years after brachytherapy. Biopsies at 18 months were negative for 60% of the patients and 63% at 24 months. 3 patients were metastased after 3 years. 4 patients had severe complications with colostomy and/or urinary derivation. This technic seems to be interesting for localized prostate cancers T1 and T2 with initial psa < 25μg/l. Two third of the patients had normal psa and negative biopsies after 2 years. The rate of ano-rectal and urinary morbidity is high but is explained by the technic used at the beginning of this study