eMedicine Specialties > Urology > Cancer, Prostate

Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy): Follow-up

Author: Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Coauthor(s): Tracey L Krupski, MD, MPH, Assistant Professor, Department of Urology, University of Virginia
Contributor Information and Disclosures

Updated: Apr 27, 2009

Outcome and Prognosis

When compared with historical series using classic EBRT to treat prostate cancer, brachytherapy series appear to offer equivalent or better disease-specific survival as measured by biochemical failure rates. Patients must be appropriately selected and treated at an accredited institution. Although brachytherapy is still in its infancy, 5-, 7-, and 12-year follow-up studies suggest brachytherapy is equal to surgery in terms of biochemical recurrence.

A 12-year study by Ragde et al (2000) reported on patients treated with I-125 seeds, with or without additional EBRT.20 Of these patients, 66% and 79% of the brachytherapy alone and external radiation plus brachytherapy groups, respectively, were free of biochemical or clinical recurrence. Similarly, Kuban et al found no evidence of disease in only 64% of patients treated with I-125 at 10-year follow-up, but negative findings were found in all of these patients after posttreatment prostate biopsy.21 In patients with positive findings after prostate biopsies, only 19% remained actuarially disease-free at 10 years.

Polascik et al compared brachytherapy with radical prostatectomy and demonstrated that, at 7 years, surgery had an 87% progression-free survival rate versus 79% for brachytherapy in comparable patients.22 High-risk patients have been reported to have progression-free survival rates of 65-80%. When evaluating these control rates, careful attention must be given to variables such as the addition of EBRT or androgen ablation and length of follow-up.

However, no prospectively performed randomized studies have compared the efficacy of surgery with that of either brachytherapy or high dose external beam radiotherapy as delivered with modern treatment techniques. Because of a known migration in stage and histology between biopsy and prostatectomy specimens, any retrospective advantage must be interpreted with caution owing to differences in clinical versus pathologic staging. 

The Partin tables are the best nomogram for predicting prostate cancer spread and prognosis.

Future and Controversies

Imaging

MRI may become the standard imaging modality in the future instead of CT scanning or TRUS, in view of its superb imaging of the pelvic anatomy and the possibility of performing interventional studies in open MRI systems.

Cancer control

Early PSA recurrence and biopsy data support brachytherapy as a viable option for localized prostate cancer. Longer studies evaluating survival and disease-free recurrence will help clarify the role for brachytherapy in prostate cancer treatment. In addition, the hormonal ablation achieved with EBRT has yet to be demonstrated in the context of brachytherapy.

Adverse effects and quality of life

While initially thought to leave patients essentially free of symptoms and adverse effects, brachytherapy is now known to be associated with significant early and late adverse effects. In addition, combining brachytherapy and EBRT may result in a higher rate of complications than brachytherapy alone. Finally, the effect of brachytherapy on quality of life and sexual function is only beginning to be studied.

 


More on Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)

Overview: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Workup: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Treatment: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Follow-up: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
Multimedia: Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)
References
Further Reading
[ CLOSE WINDOW ]

References

  1. [Best Evidence] U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Aug 5 2008;149(3):185-91. [Medline].

  2. Hsing AW, Comstock GW. Serological precursors of cancer: serum hormones and risk of subsequent prostate cancer. Cancer Epidemiol Biomarkers Prev. Jan-Feb 1993;2(1):27-32. [Medline].

  3. Agency for Healthcare Research and Quality. Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer. AHRQ: Agency for Healthcare Research and Quality. Available at http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=9&DocID=79. Accessed January 15, 2009.

  4. Nag S. Brachytherapy for prostate cancer: summary of American Brachytherapy Society recommendations. Semin Urol Oncol. May 2000;18(2):133-6. [Medline].

  5. Frank SJ, Grimm PD, Sylvester JE, Merrick GS, Davis BJ, Zietman A, et al. Interstitial implant alone or in combination with external beam radiation therapy for intermediate-risk prostate cancer: a survey of practice patterns in the United States. Brachytherapy. Jan-Mar 2007;6(1):2-8. [Medline].

  6. Herstein A, Wallner K, Merrick G, Mitsuyama H, Armstrong J, True L, et al. I-125 versus Pd-103 for low-risk prostate cancer: long-term morbidity outcomes from a prospective randomized multicenter controlled trial. Cancer J. Sep-Oct 2005;11(5):385-9. [Medline].

  7. Niehaus A, Merrick GS, Butler WM, Wallner KE, Allen ZA, Galbreath RW, et al. The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy. Int J Radiat Oncol Biol Phys. Jan 1 2006;64(1):136-43. [Medline].

  8. Urbanic JJ, Lee WR. Update on brachytherapy in localized prostate cancer: the importance of dosimetry. Curr Opin Urol. May 2006;16(3):157-61. [Medline].

  9. Petit JH, Gluck C, Kiger WS 3rd, Laury Henry D, Karasiewicz C, Talcott JA, et al. Androgen deprivation-mediated cytoreduction before interstitial brachytherapy for prostate cancer does not abrogate the elevated risk of urinary morbidity associated with larger initial prostate volume. Brachytherapy. Oct-Dec 2007;6(4):267-71. [Medline].

  10. Pilepich MV, Caplan R, Byhardt RW, Lawton CA, Gallagher MJ, Mesic JB, et al. Phase III trial of androgen suppression using goserelin in unfavorable-prognosis carcinoma of the prostate treated with definitive radiotherapy: report of Radiation Therapy Oncology Group Protocol 85-31. J Clin Oncol. Mar 1997;15(3):1013-21. [Medline].

  11. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med. Jul 31 1997;337(5):295-300. [Medline].

  12. Koutrouvelis P, Hendricks F, Lailas N, Gil-Montero G, Sehn J, Khawand N, et al. Salvage reimplantation in patient with local recurrent prostate carcinoma after brachytherapy with three dimensional computed tomography-guided permanent pararectal implant. Technol Cancer Res Treat. Aug 2003;2(4):339-44. [Medline].

  13. de la Taille A, Hayek O, Benson MC, Bagiella E, Olsson CA, Fatal M, et al. Salvage cryotherapy for recurrent prostate cancer after radiation therapy: the Columbia experience. Urology. Jan 2000;55(1):79-84. [Medline].

  14. Perrotte P, Litwin MS, McGuire EJ, Scott SM, von Eschenbach AC, Pisters LL. Quality of life after salvage cryotherapy: the impact of treatment parameters. J Urol. Aug 1999;162(2):398-402. [Medline].

  15. Greene GF, Pisters LL, Scott SM, Von Eschenbach AC. Predictive value of prostate specific antigen nadir after salvage cryotherapy. J Urol. Jul 1998;160(1):86-90. [Medline].

  16. Pisters LL, Perrotte P, Scott SM, Greene GF, von Eschenbach AC. Patient selection for salvage cryotherapy for locally recurrent prostate cancer after radiation therapy. J Clin Oncol. Aug 1999;17(8):2514-20. [Medline].

  17. Lee WR, McQuellon RP, Case LD, deGuzman AF, McCullough DL. Early quality of life assessment in men treated with permanent source interstitial brachytherapy for clinically localized prostate cancer. J Urol. Aug 1999;162(2):403-6. [Medline].

  18. Beyer DC. Permanent brachytherapy as salvage treatment for recurrent prostate cancer. Urology. Nov 1999;54(5):880-3. [Medline].

  19. Grado GL, Collins JM, Kriegshauser JS, Balch CS, Grado MM, Swanson GP, et al. Salvage brachytherapy for localized prostate cancer after radiotherapy failure. Urology. Jan 1999;53(1):2-10. [Medline].

  20. Ragde H, Korb LJ, Elgamal AA, Grado GL, Nadir BS. Modern prostate brachytherapy. Prostate specific antigen results in 219 patients with up to 12 years of observed follow-up. Cancer. Jul 1 2000;89(1):135-41. [Medline].

  21. Kuban DA, el-Mahdi AM, Schellhammer P. The significance of post-irradiation prostate biopsy with long-term follow-up. Int J Radiat Oncol Biol Phys. 1992;24(3):409-14. [Medline].

  22. Polascik TJ, Pound CR, DeWeese TL, Walsh PC. Comparison of radical prostatectomy and iodine 125 interstitial radiotherapy for the treatment of clinically localized prostate cancer: a 7-year biochemical (PSA) progression analysis. Urology. Jun 1998;51(6):884-9; discussion 889-90. [Medline].

  23. Bittner N, Merrick GS, Wallner KE, Lief JH, Butler WM, Galbreath RW. The impact of acute urinary morbidity on late urinary function after permanent prostate brachytherapy. Brachytherapy. Oct-Dec 2007;6(4):258-66. [Medline].

  24. Blasko JC. Low-dose-rate brachytherapy for prostate cancer: preplanning vs. intraoperative planning-preplanning is best. Brachytherapy. Jul-Sep 2006;5(3):139-42; discussion 145. [Medline].

  25. Blasko JC, Grimm PD, Sylsvester JE, Cavanagh W. The role of external beam radiotherapy with I-125/Pd-103 brachytherapy for prostate carcinoma. Radiother Oncol. Dec 2000;57(3):273-8. [Medline].

  26. Blasko JC, Ragde H, Luse RW, Sylvester JE, Cavanagh W, Grimm PD. Should brachytherapy be considered a therapeutic option in localized prostate cancer?. Urol Clin North Am. Nov 1996;23(4):633-50. [Medline].

  27. Borghede G, Hedelin H, Holmang S, Johansson KA, Sernbo G, Mercke C, et al. Irradiation of localized prostatic carcinoma with a combination of high dose rate iridium-192 brachytherapy and external beam radiotherapy with three target definitions and dose levels inside the prostate gland. Radiother Oncol. Sep 1997;44(3):245-50. [Medline].

  28. Caputo G. Devita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 5th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 1997.

  29. Cox JD. Moss' Radiation Oncology. In: Rationale, Technique, Results. 7th ed. St. Louis, Mo: Mosby-Year Book; 1994.

  30. Critz FA, Williams WH, Holladay CT, Levinson AK, Benton JB, Holladay DA, et al. Post-treatment PSA < or = 0.2 ng/mL defines disease freedom after radiotherapy for prostate cancer using modern techniques. Urology. Dec 1999;54(6):968-71. [Medline].

  31. Dinges S, Deger S, Koswig S, Boehmer D, Schnorr D, Wiegel T, et al. High-dose rate interstitial with external beam irradiation for localized prostate cancer--results of a prospective trial. Radiother Oncol. Aug 1998;48(2):197-202. [Medline].

  32. Horwitz EM, Vicini FA, Ziaja EL, Dmuchowski CF, Stromberg JS, Martinez AA. The correlation between the ASTRO Consensus Panel definition of biochemical failure and clinical outcome for patients with prostate cancer treated with external beam irradiation. American Society of Therapeutic Radiology and Oncology. Int J Radiat Oncol Biol Phys. May 1 1998;41(2):267-72. [Medline].

  33. Joly F, Brune D, Couette JE, Lesaunier F, Heron JF, Peny J, et al. Health-related quality of life and sequelae in patients treated with brachytherapy and external beam irradiation for localized prostate cancer. Ann Oncol. Jul 1998;9(7):751-7. [Medline].

  34. Kabalin JN, Hodge KK, McNeal JE, Freiha FS, Stamey TA. Identification of residual cancer in the prostate following radiation therapy: role of transrectal ultrasound guided biopsy and prostate specific antigen. J Urol. Aug 1989;142(2 Pt 1):326-31. [Medline].

  35. Koutrouvelis PG. Three-dimensional stereotactic posterior ischiorectal space computerized tomography guided brachytherapy of prostate cancer: a preliminary report. J Urol. Jan 1998;159(1):142-5. [Medline].

  36. Krupski T, Petroni GR, Bissonette EA, Theodorescu D. Quality-of-life comparison of radical prostatectomy and interstitial brachytherapy in the treatment of clinically localized prostate cancer. Urology. May 2000;55(5):736-42. [Medline].

  37. Laverdière J, Gomez JL, Cusan L, Suburu ER, Diamond P, Lemay M, et al. Beneficial effect of combination hormonal therapy administered prior and following external beam radiation therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys. Jan 15 1997;37(2):247-52. [Medline].

  38. Lee WR. The role of androgen deprivation therapy combined with prostate brachytherapy. Urology. Sep 2002;60(3 Suppl 1):39-44; discussion 44. [Medline].

  39. Long JP, Bahn D, Lee F, Shinohara K, Chinn DO, Macaluso JN Jr. Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate. Urology. Mar 2001;57(3):518-23. [Medline].

  40. Mazeron JJ. Brachytherapy: a new era. Radiother Oncol. Mar 2005;74(3):223-5. [Medline].

  41. McNeal J, Noldus J. Limitations of transition zone needle biopsy findings in the prediction of transition zone cancer and tissue composition of benign nodular hyperplasia. Urology. Nov 1996;48(5):751-6. [Medline].

  42. Merrick GS, Butler WM, Galbreath RW, Lief JH, Adamovich E. Biochemical outcome for hormone-naive patients with Gleason score 3+4 versus 4+3 prostate cancer undergoing permanent prostate brachytherapy. Urology. Jul 2002;60(1):98-103. [Medline].

  43. Merrill RM, Weed DL, Feuer EJ. The lifetime risk of developing prostate cancer in white and black men. Cancer Epidemiol Biomarkers Prev. Oct 1997;6(10):763-8. [Medline].

  44. Miller DC, Sanda MG, Dunn RL, Montie JE, Pimentel H, Sandler HM, et al. Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy. J Clin Oncol. Apr 20 2005;23(12):2772-80. [Medline].

  45. Nag S, Beyer D, Friedland J, Grimm P, Nath R. American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys. Jul 1 1999;44(4):789-99. [Medline].

  46. Nag S, Bice W, DeWyngaert K, Prestidge B, Stock R, Yu Y. The American Brachytherapy Society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis. Int J Radiat Oncol Biol Phys. Jan 1 2000;46(1):221-30. [Medline].

  47. Nag S, Ciezki JP, Cormack R, Doggett S, DeWyngaert K, Edmundson GK, et al. Intraoperative planning and evaluation of permanent prostate brachytherapy: report of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys. Dec 1 2001;51(5):1422-30. [Medline].

  48. Nag S, Ellis RJ, Merrick GS, Bahnson R, Wallner K, Stock R, et al. American Brachytherapy Society recommendations for reporting morbidity after prostate brachytherapy. Int J Radiat Oncol Biol Phys. Oct 1 2002;54(2):462-70. [Medline].

  49. Neill M, Studer G, Le L, McLean M, Yeung I, Pond G. The nature and extent of urinary morbidity in relation to prostate brachytherapy urethral dosimetry. Brachytherapy. Jul-Sep 2007;6(3):173-9. [Medline].

  50. Ragde H, Elgamal AA, Snow PB, Brandt J, Bartolucci AA, Nadir BS, et al. Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high Gleason grade prostate carcinoma. Cancer. Sep 1 1998;83(5):989-1001. [Medline].

  51. Ray ME, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, et al. PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys. Mar 15 2006;64(4):1140-50. [Medline].

  52. Stamey TA, McNeal JE, Yemoto CM, Sigal BM, Johnstone IM. Biological determinants of cancer progression in men with prostate cancer. JAMA. Apr 21 1999;281(15):1395-400. [Medline].

  53. Stock RG, Stone NN, Iannuzzi C. Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys. May 1 1996;35(2):267-72. [Medline].

  54. Stromberg J, Martinez A, Gonzalez J, Edmundson G, Ohanian N, Vicini F, et al. Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. Int J Radiat Oncol Biol Phys. Aug 30 1995;33(1):161-71. [Medline].

  55. Theodorescu D, Gillenwater JY, Koutrouvelis PG. Prostatourethral-rectal fistula after prostate brachytherapy. Cancer. Nov 15 2000;89(10):2085-91. [Medline].

  56. Vicini FA, Vargas C, Edmundson G, Kestin L, Martinez A. The role of high-dose rate brachytherapy in locally advanced prostate cancer. Semin Radiat Oncol. Apr 2003;13(2):98-108. [Medline].

  57. Waller K, Blasko J, Dattoli MJ. Prostate Brachytherapy Made Complicated. ed. Seattle, Wash: SmartMedicine; 1997.

  58. Wallner K, Lee H, Wasserman S, Dattoli M. Low risk of urinary incontinence following prostate brachytherapy in patients with a prior transurethral prostate resection. Int J Radiat Oncol Biol Phys. Feb 1 1997;37(3):565-9. [Medline].

  59. Zelefsky MJ, Nedelka MA, Arican ZL, Yamada Y, Cohen GN, Shippy AM, et al. Combined brachytherapy with external beam radiotherapy for localized prostate cancer: Reduced morbidity with an intraoperative brachytherapy planning technique and supplemental intensity-modulated radiation therapy. Brachytherapy. Jan-Mar 2008;7(1):1-6. [Medline].

  60. Zelefsky MJ, Wallner KE, Ling CC, Raben A, Hollister T, Wolfe T, et al. Comparison of the 5-year outcome and morbidity of three-dimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early-stage prostatic cancer. J Clin Oncol. Feb 1999;17(2):517-22. [Medline].

  61. Zelefsky MJ, Whitmore WF Jr. Long-term results of retropubic permanent 125iodine implantation of the prostate for clinically localized prostatic cancer. J Urol. Jul 1997;158(1):23-9; discussion 29-30. [Medline].

  62. Zelefsky MJ, Zaider M. Low-dose-rate brachytherapy for prostate cancer: preplanning vs. intraoperative planning-intraoperative planning is best. Brachytherapy. Jul-Sep 2006;5(3):143-4; discussion 146. [Medline].

[ CLOSE WINDOW ]

Further Reading

For more information, visit Medscape’s Prostate Cancer Resource Center.

[ CLOSE WINDOW ]

Keywords

prostate brachytherapy, radioactive seed implantation therapy, interstitial brachytherapy, prostate cancer, prostate adenocarcinoma, adenocarcinoma of the prostate, radioactive implant therapy, prostatic brachytherapy, prostate therapy, adjuvant prostate cancer therapy, seed therapy, iodine-125, palladium-103, organ-confined prostate cancer, organ confined prostate cancer, iridium-192, radiopharmaceutical for prostate cancer, radioactive isotope therapy, HDRB, high dose rate brachytherapy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

Coauthor(s)

Tracey L Krupski, MD, MPH, Assistant Professor, Department of Urology, University of Virginia
Tracey L Krupski, MD, MPH is a member of the following medical societies: American Medical Association, American Society of Clinical Oncology, American Urological Association, and Society of Women in Urology
Disclosure: Nothing to disclose.

Medical Editor

Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Martin I Resnick, MD †, Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine
Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.