Combined interstitial and external irradiation for prostatic cancer

There is very good evidence to support the concept that irradiation therapy can destroy prostatic cancer. Patients with localized disease can be cured with radiotherapy. But controversy continues regarding the best therapeutic technique, the complications associated with definitive therapy, the relative merits of irradiation therapy versus radical surgery, the role of staging pelvic lymphadenectomy, the appropriate stages for treatment, the interpretation of postirradiation biopsy results, and the dynamics of the response of this tumor to a course of irradiation. Since 1965, at the authors' institution the authors have treated most patients who have localized prostatic cancer with a combined approach utilizing implantation of radioactive gold seeds into the prostrate followed by external beam irradiation. This is the technique with which they are most familiar. Excellent reviews have recently been published on the technique of definitive external irradiation. This review focusses on the experience at Baylor using the combined technique and will mention the alternative forms of radiotherapy only for comparison