Palladium-103 Brachytherapy as the Primary Treatment for Prostate Adenocarcinoma: Minimum Five-year Follow-up

Michael B Williams, Mark Shaves, Paul F Schellhammer
Eastern Virginia Medical School, Norfolk, VA

Introduction: Brachytherapy is frequently utilized in the primary treatment of prostate adenocarcinoma (CaP). We report our experience with 136 consecutive patients with five-year minimum follow-up.
Methods: All patients receiving brachytherapy between the years 1994-2000 were divided into low, intermediate, and high-risk categories based on Gleason score, TNM classification, and pre-treatment PSA. Overall survival (OS), cancer-specific survival (CaPS), biochemical recurrence free survival (BRFS), absolute nadir PSA, time to nadir PSA, and post-implantation genitourinary/gastrointestinal complications were analyzed.
Results: Mean age of the 136 patients at brachytherapy implantation was 65 ± 0.6 years. Median follow-up is 6.5 years. Seventy-seven of the 136 patients received androgen blockade three-months prior to brachytherapy for prostate volume reduction. Low (n=66), Intermediate (n=49), and High Risk (n=20) categories were stratified. No significant differences were found in absolute nadir PSA, OS, BRFS, or CaPS. Time to nadir PSA was significantly longer for low risk (34 ± 3.4 months) than for intermediate (21 ± 3.7 months). Biochemical recurrence was found in 3% of low, 10% of intermediate, and 15% of high-risk patients. 72 patients reported Grade I urinary toxicity in the immediate post-implant phase. Only 19 patients continued with these complaints past one year.
Conclusions: Brachytherapy, as a primary treatment for CaP, is associated with an excellent 5-year biochemical recurrence disease free outcome with minimal associated morbidity.

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