10-year biochemical (prostate-specific antigen) control of prostate cancer with 125I brachytherapy


      Math Eq To report 10-year biochemical (prostate-specific antigen [PSA]) outcomes for patients treated with 125I brachytherapy as monotherapy for early-stage prostate cancer.
      Math Eq One hundred and twenty-five consecutively treated patients, with clinical Stage T1-T2b prostate cancer were treated with 125I brachytherapy as monotherapy, and followed with PSA determinations. Kaplan-Meier estimates of PSA progression-free survival (PFS), on the basis of a two consecutive elevations of PSA, were calculated. Aggregate PSA response by time interval was assessed. Comparisons were made to an earlier-treated cohort.
      Math Eq The overall PSA PFS rate achieved at 10 years was 87% for low-risk patients (PSA < 10, Gleason Sum 2–6, T1-T2b). Of 59 patients (47%) followed beyond 7 years, 51 (86%) had serum PSAs less than 0.5 ng/mL; 48 (81%) had serum PSAs less than 0.2 ng/mL. Failures were local, 3.0%; distant, 3.0%. No patients have died of prostate carcinoma. The proportion of patients with a PSA ≤ 0.2 ng/mL continued to increase until at least 7–8 years posttherapy. A plot of PSA PFS against the proportion of patients achieving serum PSA of less than 0.2 ng/mL suggests a convergence of these two endpoints at 10 years. Patients treated in the era of this study (1988–1990) experienced a statistically improved PFS compared with an earlier era (1986–1987). This difference appears independent of patient selection, suggesting that the maturation of the technique resulted in improved biochemical control.
      Math Eq With modern technique, monotherapy with 125I achieves a high rate (87%) of biochemical and clinical control in patients with low-risk disease at 10 years. The decline of PSA following brachytherapy with low-dose-rate isotopes can be protracted. Absolute PSA and PFS curves merge, and are comparable at 10 years.


      To read this article in full you will need to make a payment
      ASTRO Member Login
      ASTRO Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Grimm P.D
        • Blasko J.C
        • Ragde H
        Ultrasound-guided transperineal implantation of Iodine-125 and Palladium-103 for the treatment of early-stage prostate cancer.
        in: Schellhammer P.F New techniques in prostate surgery. WB Saunders Co, Philadelphia1994: 113-126
        • American Joint Committe on Prostate Cancer
        Beahrs O.H Henson D.E Hutter R.V.P Kennedy B.J Manual for staging of cancer. 4th ed. JB Lippincott, Philadelphia1992: 181-183
      1. Consensus statement. Guidelines for PSA following radiation therapy.
        Int J Radiat Oncol Biol Phys. 1997; 37: 1035-1041
        • Zelefsky M.J
        • Leibel S.A
        • Gaudin P.B
        • et al.
        Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer.
        Int J Radiat Oncol Biol Phys. 1998; 41: 491-500
        • Cavanagh W
        • Blasko J.C
        • Grimm P.D
        • et al.
        Transient elevation of serum prostate-specific antigen following 125I/103Pd brachytherapy for localized prostate cancer.
        Semin Urol Oncol. 2000; 18: 160-165
        • Critz F.A
        • Williams W.H
        • Benton J.B
        • et al.
        Prostate specific antigen bounce after radioactive seed implantation followed by external beam radiation for prostate cancer.
        J Urol. 2000; 163: 1085-1089
        • Steinberg D.M
        • Sauvageot J
        • Piantadosi S
        • et al.
        Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings.
        Am J Surg Pathol. 1997; 21: 566-576
        • Iczkowski K.A
        • Bostwick D.G
        The pathologist as optimist.
        Am J Surg Pathol. 1998; 22 (Editorial): 1169-1170
        • Critz F.A
        • Williams W.H
        • Holladay C.T
        • et al.
        Post-treatment PSA < or = 0.2 ng/mL defines disease freedom after radiotherapy for prostate cancer using modern techniques.
        Urology. 1999; 54: 968-971
        • Ragde H
        • Korb L.J
        • Elgamal A.A
        • et al.
        Modern prostate brachytherapy. Prostate specific antigen results in 219 patients with up to 12 years of observed follow-up.
        Cancer. 2000; 89: 135-141
        • Blasko J.C
        • Grimm P.D
        • Sylvester J.E
        • et al.
        Palladium-103 brachytherapy for prostate carcinoma.
        Int J Radiat Oncol Biol Phys. 2000; 46: 839-850
        • Zelefsky M.J
        • Wallner K.E
        • Ling C.C
        • 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. 1999; 17: 517-522
        • D’Amico A.V
        • Whittington R
        • Malkowicz S.B
        • et al.
        Clinical utility of the percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer.
        J Clin Oncol. 2000; 18 (See comments): 1164-1172


      Commenting Guidelines

      To submit a comment for a journal article, please use the space above and note the following:

      • We will review submitted comments as soon as possible, striving for within two business days.
      • This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise inappropriate will not be posted.
      • We require that commenters identify themselves with names and affiliations.
      • Comments must be in compliance with our Terms & Conditions.
      • Comments are not peer-reviewed.