Abstract
Prostate brachytherapy with permanent radioactive implants is becoming an increasingly popular treatment choice for patients with prostate cancer. This therapy is attractive to patients due to the fact that it is an outpatient procedure and in many cases has been associated with lower long-term risks of urinary incontinence and erectile dysfunction when compared to other curative modalities. This review will describe the history, isotopes used, implantation techniques, and results achieved with modern prostate brachytherapy. Results will be discussed both in terms of cancer control and health-related quality of life endpoints.
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References
Hall JD, Boyd JC, Lippert MC, Theodorescu D (2003) Why patients choose prostatectomy or brachytherapy for localized prostate cancer: results of a descriptive survey. Urology 61:402–407
Pasteau D (1913) The radium treatment of cancer of the prostate. Arch Roentgenol Ray 28:396
Flocks R, Kerr H, Elkins H, Mador D (1959) The treatment of carcinoma of the prostate by interstitial radiation with radioactive gold: a follow-up report. J Urol 71:628–633
Whitmore WF Jr, Hilaris B, Grabstald H (1972) Retropubic implantation to iodine 125 in the treatment of prostatic cancer. J Urol 108:918–920
Zelefsky MJ, Whitmore WF Jr (1997) Long-term results of retropubic permanent 125iodine implantation of the prostate for clinically localized prostatic cancer. J Urol 158:23–29; discussion 29–30
Watanabe H, Igari D, Tanahashi Y, Harada K, Saitoh M (1975) Transrectal ultrasonotomography of the prostate. J Urol 114:734–739
Holm HH, Juul N, Pedersen JF, Hansen H, Stroyer I (1983) Transperineal 125iodine seed implantation in prostatic cancer guided by transrectal ultrasonography. J Urol 130:283–286
Nag S, Bice W, DeWyngaert K, Prestidge B, Stock R, Yu Y (2000) The American Brachytherapy Society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis. Int J Radiat Oncol Biol Phys 46:221–230
Blasko JC, Grimm PD, Sylvester JE, Badiozamani KR, Hoak D, Cavanagh W (2000) Palladium-103 brachytherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 46:839–850
Langley SE, Laing R (2002) Prostate brachytherapy has come of age: a review of the technique and results. BJU Int 89:241–249
Ling CC (1992) Permanent implants using Au-198, Pd-103 and I-125: radiobiological considerations based on the linear quadratic model. Int J Radiat Oncol Biol Phys 23:81–87
Nag S, Scaperoth DD, Badalament R, Hall SA, Burgers J (1995) Transperineal palladium 103 prostate brachytherapy: analysis of morbidity and seed migration. Urology 45:87–92
Beyer DC, Priestley JB Jr (1997) Biochemical disease-free survival following 125I prostate implantation. Int J Radiat Oncol Biol Phys 37:559–563
Blasko JC, Wallner K, Grimm PD, Ragde H (1995) Prostate specific antigen based disease control following ultrasound guided 125iodine implantation for stage T1/T2 prostatic carcinoma. J Urol 154:1096–1099
Dattoli M, Wallner K, Sorace R, Koval J, Cash J, Acosta R, Brown C, Etheridge J, Binder M, Brunelle R, Kirwan N, Sanchez S, Stein D, Wasserman S (1996) 103Pd brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma (see comments). Int J Radiat Oncol Biol Phys 35:875–879
Ragde H, Blasko JC, Grimm PD, Kenny GM, Sylvester J, Hoak DC, Cavanagh W, Landin K (1997) Brachytherapy for clinically localized prostate cancer: results at 7- and 8-year follow-up [published erratum appears in (1998) Semin Surg Oncol 14:185]. Semin Surg Oncol 13:438–443
Cha CM, Potters L, Ashley R, Freeman K, Wang XH, Waldbaum R, Leibel S (1999) Isotope selection for patients undergoing prostate brachytherapy. Int J Radiat Oncol Biol Phys 45:391–395
Vicini FA, Vargas C, Edmundson G, Kestin L, Martinez A (2003) The role of high-dose rate brachytherapy in locally advanced prostate cancer. Semin Radiat Oncol 13:98–108
Stone NN, Stock RG (2000) Prostate brachytherapy in patients with prostate volumes >/= 50 cm(3): dosimetric analysis of implant quality. Int J Radiat Oncol Biol Phys 46:1199–1204
Krupski T, Bissonette EA, Petroni GR, Theodorescu D (2003) The impact of prostate volume following neoadjuvant androgen deprivation on quality of life and voiding symptoms in patients undergoing permanent prostate brachytherapy. Eur Urol 43:467–472
Terk MD, Stock RG, Stone NN (1998) Identification of patients at increased risk for prolonged urinary retention following radioactive seed implantation of the prostate. J Urol 160:1379–1382
Merrick GS, Butler WM, Wallner KE, Lief JH, Galbreath RW (2002) Prophylactic versus therapeutic alpha-blockers after permanent prostate brachytherapy. Urology 60:650–655
Hughes S, Wallner K, Merrick G, Miller S, True LD (2001) Preexisting histologic evidence of prostatitis is unrelated to postimplant urinary morbidity. Int J Cancer 96 [Suppl]:79–82
Wallner K, Lee H, Wasserman S, Dattoli M (1997) Low risk of urinary incontinence following prostate brachytherapy in patients with a prior transurethral prostate resection. Int J Radiat Oncol Biol Phys, 37:565–569
Stone NN, Ratnow ER, Stock RG (2000) Prior transurethral resection does not increase morbidity following real-time ultrasound-guided prostate seed implantation. Tech Urol 6:123–127
Krupski T, Petroni GR, Bissonette EA, Theodorescu D (2000) Quality-of-life comparison of radical prostatectomy and interstitial brachytherapy in the treatment of clinically localized prostate cancer. Urology 55:736–742
Nag S, Beyer D, Friedland J, Grimm P, Nath R (1999) American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 44:789–799
Grann A, Gaudin PB, Raben A, Wallner K (1998) Pathologic features from prostate needle biopsy and prognosis after I-125 brachytherapy. Radiat Oncol Investig 6:170–174
Merrick GS, Butler WM, Galbreath RW, Lief JH, Adamovich E (2002) Relationship between percent positive biopsies and biochemical outcome after permanent interstitial brachytherapy for clinically organ-confined carcinoma of the prostate gland. Int J Radiat Oncol Biol Phys 52:664–673
Kestin LL, Goldstein NS, Vicini FA, Martinez AA (2002) Percentage of positive biopsy cores as predictor of clinical outcome in prostate cancer treated with radiotherapy. J Urol 168:1994–1999
Nag S, Ciezki JP, Cormack R, Doggett S, DeWyngaert K, Edmundson GK, Stock RG, Stone NN, Yu Y, Zelefsky MJ (2001) Intraoperative planning and evaluation of permanent prostate brachytherapy: report of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys 51:1422–1430
Grimm P, Blasko J, Ragde H (1994) Ultrasound-guided transperineal implantation of iodine-125 and palladium-103 for treatment of early stage prostate cancer. Technical concepts in planning, operative technique, and evaluation. Urol Clin North Am 2:113–125
Kucway R, Vicini F, Huang R, Stromberg J, Gonzalez J, Martinez A (2002) Prostate volume reduction with androgen deprivation therapy before interstitial brachytherapy. J Urol 167:2443–2447
Stock RG, Stone NN, Wesson MF, DeWyngaert JK (1995) A modified technique allowing interactive ultrasound-guided three- dimensional transperineal prostate implantation. Int J Radiat Oncol Biol Phys 32:219–225
Shanahan TG, Nanavati PJ, Mueller PW, Maxey RB (2002) A comparison of permanent prostate brachytherapy techniques: preplan vs. hybrid interactive planning with postimplant analysis. Int J Radiat Oncol Biol Phys 53:490–496
Koutrouvelis PG (1998) Three-dimensional stereotactic posterior ischiorectal space computerized tomography guided brachytherapy of prostate cancer: a preliminary report. J Urol 159:142–145
Brown D, Colonias A, Miller R, Benoit R, Cohen J, Arshoun Y, Galloway M, Karlovits S, Wu A, Johnson M, Quinn A, Kalnicki S (2000) Urinary morbidity with a modified peripheral loading technique of transperineal (125)i prostate implantation. Int J Radiat Oncol Biol Phys 47:353–360
Biggs PJ, Kelley DM (1983) Geometric reconstruction of seed implants using a three-film technique. Med Phys 10:701–704
Roy JN, Wallner KE, Harrington PJ, Ling CC, Anderson LL (1993) A CT-based evaluation method for permanent implants: application to prostate. Int J Radiat Oncol Biol Phys 26:163–169
Lee WR, Roach M 3rd, Michalski J, Moran B, Beyer D (2002) Interobserver variability leads to significant differences in quantifiers of prostate implant adequacy. Int J Radiat Oncol Biol Phys 54:457–461
Willins J, Wallner K (1997) CT-based dosimetry for transperineal I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys 39:347–353
Moerland MA, Wijrdeman HK, Beersma R, Bakker CJ, Battermann JJ (1997) Evaluation of permanent I-125 prostate implants using radiography and magnetic resonance imaging. Int J Radiat Oncol Biol Phys 37:927–933
Dubois DF, Prestidge BR, Hotchkiss LA, Bice WS Jr, Prete JJ (1997) Source localization following permanent transperineal prostate interstitial brachytherapy using magnetic resonance imaging. Int J Radiat Oncol Biol Phys 39:1037–1041
Hurwitz MD, Cormack R, Tempany CM, Kumar S, D'Amico AV (2000) Three-dimensional real-time magnetic resonance-guided interstitial prostate brachytherapy optimizes radiation dose distribution resulting in a favorable acute side effect profile in patients with clinically localized prostate cancer. Tech Urol 6:89–94
D'Amico A, Cormack R, Kumar S, Tempany CM (2000) Real-time magnetic resonance imaging-guided brachytherapy in the treatment of selected patients with clinically localized prostate cancer. J Endourol 14:367–370
D'Amico AV, Tempany CM, Cormack R, Hata N, Jinzaki M, Tuncali K, Weinstein M, Richie JP (2000) Transperineal magnetic resonance image guided prostate biopsy. J Urol 164:385–387
Cormack RA, Kooy H, Tempany CM, D'Amico AV (2000) A clinical method for real-time dosimetric guidance of transperineal 125I prostate implants using interventional magnetic resonance imaging. Int J Radiat Oncol Biol Phys 46:207–214
Yue N, Chen Z, Peschel R, Dicker AP, Waterman FM, Nath R (1999) Optimum timing for image-based dose evaluation of 125I and 103PD prostate seed implants. Int J Radiat Oncol Biol Phys 45:1063–1072
Yue N, Dicker AP, Corn BW, Nath R, Waterman FM (1999) A dynamic model for the estimation of optimum timing of computed tomography scan for dose evaluation of 125I or 103Pd seed implant of prostate. Int J Radiat Oncol Biol Phys 43:447–454
Yue N, Dicker AP, Nath R, Waterman FM (1999) The impact of edema on planning 125I and 103Pd prostate implants. Med Phys 26:763–767
Waterman FM, Yue N, Corn BW, Dicker AP (1998) Edema associated with I-125 or Pd-103 prostate brachytherapy and its impact on post-implant dosimetry: an analysis based on serial CT acquisition. Int J Radiat Oncol Biol Phys 41:1069–1077
Merrick GS, Butler WM, Wallner KE, Galbreath RW, Lief JH (2003) Long-term urinary quality of life after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 56:454–461
Van Gellekom MP, Moerland MA, Kal HB, Battermann JJ (2002) Biologically effective dose for permanent prostate brachytherapy taking into account postimplant edema. Int J Radiat Oncol Biol Phys 53:422–433
Storey MR, Landgren RC, Cottone JL, Stallings JW, Logan CW, Fraiser LP, Ross CS, Kock RJ, Berkley LW, Hauer-Jensen M (1999) Transperineal 125iodine implantation for treatment of clinically localized prostate cancer: 5-year tumor control and morbidity. Int J Radiat Oncol Biol Phys 43:565–570
Ramos CG, Carvalhal GF, Smith DS, Mager DE, Catalona WJ (1999) Retrospective comparison of radical retropubic prostatectomy and 125iodine brachytherapy for localized prostate cancer. J Urol 161:1212–1215
Ragde H, Elgamal AA, Snow PB, Brandt J, Bartolucci AA, Nadir BS, Korb LJ (1998) 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 83:989–1001
Ragde H, Korb LJ, Elgamal AA, Grado GL, Nadir BS (2000) Modern prostate brachytherapy. Prostate specific antigen results in 219 patients with up to 12 years of observed follow-up. Cancer 89:135–141
Blasko JC, Grimm PD, Sylsvester JE, Cavanagh W (2000) The role of external beam radiotherapy with I-125/Pd-103 brachytherapy for prostate carcinoma. Radiother Oncol 57:273–278
Merrick GS, Butler WM, Lief JH, Galbreath RW, Adamovich E (2002) Biochemical outcome for hormone-naive patients with high-risk prostate cancer managed with permanent interstitial brachytherapy and supplemental external-beam radiation. Cancer J 8:322–327
D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer (see comments). JAMA 280:969–974
Dattoli M, Wallner K, True L, Sorace R, Koval J, Cash J, Acosta R, Biswas M, Binder M, Sullivan B, Lastarria E, Kirwan N, Stein D (1999) Prognostic role of serum prostatic acid phosphatase for 103Pd-based radiation for prostatic carcinoma. Int J Radiat Oncol Biol Phys 45:853–856
Grado GL, Larson TR, Balch CS, Grado MM, Collins JM, Kriegshauser JS, Swanson GP, Navickis RJ, Wilkes MM (1998) Actuarial disease-free survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance. Int J Radiat Oncol Biol Phys 42:289–298
D'Amico AV (2002) Radiation and hormonal therapy for locally advanced and clinically localized prostate cancer. Urology 60:32–37; discussion 37–38
Pilepich MV, Krall JM, al-Sarraf M, John MJ, Doggett RL, Sause WT, Lawton CA, Abrams RA, Rotman M, Rubin P, et al. (1995) Androgen deprivation with radiation therapy compared with radiation therapy alone for locally advanced prostatic carcinoma: a randomized comparative trial of the Radiation Therapy Oncology Group. Urology 45:616–623
Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, Bernier J, Kuten A, Sternberg C, Gil T, Collette L, Pierart M (1997) Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 337:295–300
Coblentz TR, Bissonette EA, Williams KR, Theodorescu D (2002) Multimodality radiotherapy and androgen ablation in the treatment of clinically localized prostate cancer: early results in high risk patients. Prostate Cancer Prostatic Dis 5:219–225
Cox J, Grignon D, Kaplan R (1997) Consensus statement: guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 37:1035–1041
Desai J, Stock RG, Stone NN, Iannuzzi C, DeWyngaert JK (1998) Acute urinary morbidity following I-125 interstitial implantation of the prostate gland. Radiat Oncol Investig 6:135–141
Brown D, Colonias A, Miller R, Benoit R, Cohen J, Arshoun Y, Galloway M, Karlovits S, Wu A, Johnson M, Quinn A, Kalnicki S (2000) Urinary morbidity with a modified peripheral loading technique of transperineal (125)i prostate implantation. Int J Radiat Oncol Biol Phys 47:353–360
Terk MD, Stock RG, Stone NN (1998) Identification of patients at increased risk for prolonged urinary retention following radioactive seed implantation of the prostate. J Urol 160:1379–1382
Gelblum DY, Potters L, Ashley R, Waldbaum R, Wang XH, Leibel S (1999) Urinary morbidity following ultrasound-guided transperineal prostate seed implantation. Int J Radiat Oncol Biol Phys 45:59–67
Elshaikh MA, Angermeier K, Ulchaker JC, Klein EA, Chidel MA, Mahoney S, Wilkinson DA, Reddy CA, Ciezki JP (2003) Effect of anatomic, procedural, and dosimetric variables on urinary retention after permanent iodine-125 prostate brachytherapy. Urology 61:152–155
Merrick GS, Butler WM, Wallner KE, Galbreath RW, Murray B, Zeroski D, Lief JH (2003) Dysuria after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 55:979–985
Arterbery VE, Frazier A, Dalmia P, Siefer J, Lutz M, Porter A (1997) Quality of life after permanent prostate implant. Semin Surg Oncol 13:461–464
Fulmer BR, Bissonette EA, Petroni GR, Theodorescu D (2001) Prospective assessment of voiding and sexual function after treatment for localized prostate carcinoma: comparison of radical prostatectomy to hormonobrachytherapy with and without external beam radiotherapy. Cancer 91:2046–2055
Brandeis JM, Litwin MS, Burnison CM, Reiter RE (2000) Quality of life outcomes after brachytherapy for early stage prostate cancer. J Urol 163:851–857
Egawa S, Shimura S, Irie A, Kitano M, Nishiguchi I, Kuwao S, Hayakawa K, Baba S (2001) Toxicity and health-related quality of life during and after high dose rate brachytherapy followed by external beam radiotherapy for prostate cancer. Jpn J Clin Oncol 31:541–547
Beyer D, Nath R, Butler W, Merrick G, Blasko J, Nag S, Orton C (2000) American brachytherapy society recommendations for clinical implementation of NIST-1999 standards for (103)palladium brachytherapy. The clinical research committee of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys 47:273–275
Merrick GS, Butler WM, Wallner KE, Lief JH, Galbreath RW (2002) Prophylactic versus therapeutic alpha-blockers after permanent prostate brachytherapy. Urology 60:650–655
Wallner K, Lee H, Wasserman S, Dattoli M (1997) Low risk of urinary incontinence following prostate brachytherapy in patients with a prior transurethral prostate resection. Int J Radiat Oncol Biol Phys 37:565–569
Zelefsky MJ, Hollister T, Raben A, Matthews S, Wallner KE (2000) Five-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 47:1261–1266
Keetch DW, Andriole GL, Catalona WJ (1994) Complications of radical retropubic prostatectomy. AUA Update Series 13
Catalona WJ, Ramos CG, Carvalhal GF (1999) Contemporary results of anatomic radical prostatectomy. CA Cancer J Clin 49:282–296
Walsh PC, Marschke P, Ricker D, Burnett AL (2000) Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 55:58–61
DiBiase SJ, Wallner K, Tralins K, Sutlief S (2000) Brachytherapy radiation doses to the neurovascular bundles. Int J Radiat Oncol Biol Phys 46:1301–1307
Fisch BM, Pickett B, Weinberg V, Roach M (2001) Dose of radiation received by the bulb of the penis correlates with risk of impotence after three-dimensional conformal radiotherapy for prostate cancer. Urology 57:955–959
Merrick GS, Wallner K, Butler WM, Lief JH, Sutlief S (2001) Short-term sexual function after prostate brachytherapy. Int J Cancer 96:313–319
Ravery V (2001) Brachytherapy versus radical prostatectomy. BJU Int 87:141–143
Valicenti RK, Bissonette EA, Chen C, Theodorescu D (2002) Longitudinal comparison of sexual function after 3-dimensional conformal radiation therapy or prostate brachytherapy. J Urol 168:2499–2504; discussion 2504
Zelefsky MJ, Wallner KE, Ling CC, Raben A, Hollister T, Wolfe T, Grann A, Gaudin P, Fuks Z, Leibel SA (1999) 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 17:517–522
Stock RG, Kao J, Stone NN (2001) Penile erectile function after permanent radioactive seed implantation for treatment of prostate cancer. J Urol 165:436–439
Merrick GS, Butler WM, Dorsey AT, Lief JH, Donzella JG (2000) A comparison of radiation dose to the neurovascular bundles in men with and without prostate brachytherapy-induced erectile dysfunction. Int J Radiat Oncol Biol Phys 48:1069–1074
Hollenbeck BK, Dunn RL, Wei JT, McLaughlin PW, Han M, Sanda MG (2002) Neoadjuvant hormonal therapy and older age are associated with adverse sexual health-related quality-of-life outcome after prostate brachytherapy. Urology 59:480–484
Miller NL, Bissonette EA, Bahnson R, Wilson J, Theodorescu D (2003) Impact of a novel neoadjuvant and adjuvant hormone-deprivation approach on quality of life, voiding function, and sexual function after prostate brachytherapy. Cancer 97:1203–1210
Potters L, Torre T, Fearn PA, Leibel SA, Kattan MW (2001) Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 50:1235–1242
Merrick GS, Butler WM, Galbreath RW, Stipetich RL, Abel LJ, Lief JH (2002) Erectile function after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 52:893–902
Wei JT, Dunn RL, Sandler HM, McLaughlin PW, Montie JE, Litwin MS, Nyquist L, Sanda MG (2002) Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. J Clin Oncol 20:557–566
Neerhut GJ, Wheeler T, Cantini M, Scardino PT (1988) Salvage radical prostatectomy for radiorecurrent adenocarcinoma of the prostate. J Urol 140:544–549
Ghafar MA, Johnson CW, De La Taille A, Benson MC, Bagiella E, Fatal M, Olsson CA, Katz AE (2001) Salvage cryotherapy using an argon based system for locally recurrent prostate cancer after radiation therapy: the Columbia experience. J Urol 166:1333–1337; discussion 1337–1338
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Woolsey, J., Miller, N. & Theodorescu, D. Permanent interstitial brachytherapy for prostate cancer: a current review. World J Urol 21, 209–219 (2003). https://doi.org/10.1007/s00345-003-0357-9
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DOI: https://doi.org/10.1007/s00345-003-0357-9