Radioisotopic implantation for carcinoma of the prostate: does it work better than it used to?

Transperineal interstitial permanent prostate brachytherapy is being selected as the treatment of choice for early-stage prostatic carcinoma with increasing frequency by both patients and medical practitioners. This trend is surprising to many who are aware of the disappointing results following the retropubic technique of a few decades ago. Others advocate that the newer techniques, which use technologically advanced imaging of the prostate and sophisticated treatment planning systems, allow highly conformal source placement within the gland, resulting in a dose distribution that is superior to that previously achieved. Does improved dose distribution correlate with a higher local control rates in prostate implant patients? This review compares the historical technique of open laparotomy and retropubic implantation as practiced at Memorial Sloan-Kettering Cancer Center in the 1970s to the contemporary technique of transperineal ultrasound-guided permanent seed placement of the 1990s. The results to date show that the present techniques are producing substantially better outcomes, probably resulting from better patient selection as well as improved dose delivery. This is a US government work. There are no restrictions on its use.