Preliminary Observations on the Results of Combined 125 Iodine Seed Implantation and External Irradiation for Carcinoma of the Prostate

Abstract

Patients (57) with localized carcinoma of the prostate were treated with pelivic lymphadenectomy and a reduced 125I implant dosage, supplemented by a moderate dose of external beam radiotherapy to the whole pelvis delivered 4-6 wk later. The incidence of pelvic nodal metastases were 28% and the operative morbidity was 15%. Late radiation sequelae developed in 18 patients, including 15 patient with radiation proctitis (29%), among whom 2 (4.6%) suffered rectal ulceration and required diverting colostomy. Followup was 2 yr or longer (median 33 mo.) in 26 patients, of whom 22 (85%) are free of disease. Three patients are living with osseous metastases or local disease and there has been 1 death of prostatic carcinoma, for an absolute 2 yr survival rate of 95%. Of the 7 patients with poorly differentiated tumor and of the 8 patients with positive pelvic lymph nodes 5 and 6, respectively, remain free of disease after a minimum 2 yr followup. Potency has been lost in 20% and reduced significantly in 30% of the patients followed 18 mo. or longer. Prostatic biopsies on 28 asymptomatic patients 12-30 mo. after completion of therapy showed no tumor in 21 (75%).