Objective: We evaluated the outcome of the first 100 patients we treated with 125I implantation as definitive therapy for carcinoma of the prostate. Patients and Methods: Between February 1970 and September 1974, bilateral pelvic lymphadenectomy and retropubic implantation of 125I seeds were performed in 100 men with stage B or C carcinoma of the prostate. The records of these patients were reviewed. Preoperative evaluation included complete patient history and physical examination, excretory urography, cystoscopy and bimanual examination, acid and alkaline phosphatase measurements, and skeletal survey (56 patients) or bone scan (44 patients). Ninety-eight patients have been followed-up for 5 years or more, and two were lost to follow-up. Local control was assessed by serial digital rectal examinations. Results: The 5- and 9-year survival rates for all patients were 83% and 52%, respectively. The 5-year survival rates for patients with clinical stage B and C disease were 87% and 77%, respectively. Variables that were associated with longer survival were low stage (an intraprostatic nodule confined to one lobe), good-to-moderate differentiation, and absence of nodal metastasis. Proportional hazard analysis of stage, grade, and nodal status showed that only nodal status had a significant independent effect on duration of survival (P = .0007). Following implantation, patients with stable or improving digital rectal findings survived longer than those with progressive local disease (P = .012). Conclusions: Analysis of crude survival curves for the first 100 patients treated with 125I implantation showed longer survival for patients with limited local disease, good-to-moderate differentiation, and absence of lymphatic metastasis. In this series, lymphatic metastasis was the only independent predictor of survival. Good local control, as determined by serial digital rectal examination, was associated with a favorable outcome. In the absence of controls, however, it is uncertain whether the latter response indicates a salutary effect of the treatment that improves survival or merely identifies a group of patients who were predetermined to have a more favorable survival.
|Original language||English (US)|
|Number of pages||4|
|Journal||Seminars in Urologic Oncology|
|State||Published - 1997|
ASJC Scopus subject areas