Preliminary results in first 100 patients treated with I-125 implantation for localized prostatic cancer

Introduction: implantation of I-125 seeds is one of the treatment modalities for localized prostatic cancer. It is cost-effective (about half the costs of external beam irradiation and about one fifth of the costs of radical prostatectomy), takes only one to three days of hospitalization and has little side effects. Material and methods: in the period October 1989 through October 1995, 100 patients underwent I-125 treatment at the Utrecht University Hospital. Age varied from 45 till 91, mean age 67.3 years. Breakdown according to stage is T0: 9, T1: 23, T2: 61 and T3: 3, with G1: 48, G2: 39, G3: 4 and Gx: 5. Initial PSA values are available since the end of 1991 and are used for follow)up. PSA value alone is not used as criterium for patient selection. Lymph node dissection was performed in 18 patients, with one patient having a positive node. The implantation is performed under spinal or general anaesthesia. Needles are placed under ultrasound guidance (B and K ultrasound system), using a fixation device and template. With the Mick applicator 3 - 5 seeds are placed through each needle. Results: survival varied from more than 6 months (92 patients) till more than 60 months (5 patients), 12 patients died, of which 3 showed progressive disease. Results of treatment were scored as NED (no signs of progression, PSA decrease and PSA value below 4 at last follow-up), stable (idem, but PSA 5 - 10 at last follow-up), or progression (signs of progression, PSA increase, PSA value above 10 at last follow-up). Excluding patients with a follow-up of less than six months, 57 patients were NED, 13 patients were stable and 18 patients showed progression. Conclusions: implantation of I-125 seeds in the treatment of localized prostate cancer offers a cost-effective, simple modality with little side effects and control rates comparable to other modalities. Longer follow-up is required to establish persisting control