10 Year Results with Seed Implants

10 Year Results with Prostate Seed Implants

The Seattle Group published their 10 year statistics with seed implants (Ragde. Cancer 1998;83:989). They noted that the PSA falls slowly after a seed implants (figure 1) and also noted that patients with low PSA do better than high (figure 2). They compared the cure rate at 10 years (NED or no evidence of disease by PSA) with the best results with traditional external beam therapy (EBT) or with surgery (radical prostatectomy or RP)

Therapy	NED at 5 y	NED at 10y
Seeds	71 - 87%	60 - 66%
Surgery (RP)	69 - 83%	47 - 73%
EBT	20 - 64%	13 - 38%

**12 Year Results with Prostate Seed Implants**
In the most recent publication (Ragde. Cancer 2000;89:135) they noted that the bNED rate (i.e. PSA < 0.5 or low and stable) was 70% at 12 years and for those treated with implant alone (160Gy I-125 with Gleason 6 or lower and stage T2b or lower) was 66% at 12 years; and for seed plus external beam (120Gy + 45Gy EBT with high risk) was 79% at 12 years. They currently recommend seed implant alone for T2a or earlier with Gleason < 7 and PSA < 10.


Until more studies are completed comparing surgery with radiation (either external beam or seed implant) the choice of 'best' treatment will remain controversial, (probably for years) the conflicting data are illustrated by the two studies shown below: Cancer 1998 Sep 1;83(5):989-1001 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. Ragde. The authors report observed 10-year brachytherapy results in the treatment of 152 consecutive patients with clinically organ-confined prostate carcinoma. Overall survival 10 years after treatment was 65%. At last follow-up only 3 of the 152 patients (2%) had died of prostate carcinoma. Ninety-seven patients (64%) remained clinically and biochemically free of disease at 10 years of follow-up and had an average PSA value of 0.18 ng/mL. Observed 10-year follow-up documents serum PSA levels superior to those reported in several published external beam irradiation series, and comparable to those published in a number of published radical prostatectomy series. Urology 1998 Jun;51(6):884-9; discussion 889-90 Comparison of radical prostatectomy and iodine 125 interstitial radiotherapy for the treatment of clinically localized prostate cancer: a 7-year biochemical (PSA) progression analysis. Polascik.To evaluate the relative efficacy of brachytherapy to radical prostatectomy, we compared biochemical progression rates from a published series of men who underwent iodine 125 (125I) interstitial radiotherapy for localized prostate cancer to a similar group of men who underwent anatomic radical prostatectomy using appropriate end points. The 7-year actuarial PSA progression-free survival following anatomic radical prostatectomy was 97.8% for this group of men selected to match the brachytherapy group, compared to 79% for men treated with 125I interstitial radiotherapy. CONCLUSIONS: Using comparative end points for biochemical-free progression, failure rates may be higher following 125I interstitial radiotherapy compared to anatomic radical prostatectomy. These data provide a better comparison of biochemical progression than previously published studies and emphasize the need for caution in interpreting the relative efficacy of brachytherapy in controlling localized prostate cancer.

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.

Comparison of radical prostatectomy and iodine 125 interstitial radiotherapy for the treatment of clinically localized prostate cancer: a 7-year biochemical (PSA) progression analysis.