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R G Stock

Publications and source records attributed to R G Stock.

At least 55 records · Page 3Linked to original sources
PubMed1997

Laparoscopic pelvic lymph node dissection for prostate cancer: comparison of the extended and modified techniques.

PURPOSE: We compared the results of extended (obturator, hypogastric, common and external iliac nodes) to modified (obturator and hypogastric nodes only) laparoscopic pelvic lymph node dissection in patients with clinically localized prostate cancer. MATERIALS AND METHODS: A total of 189 patients with stage T1 to T3 prostate cancer underwent modified (150) or extended (39) laparoscopic pelvic lymph node dissection for pelvic nodal assessment before definitive treatment. RESULTS: Twice as many lymph nodes were removed via extended than modified laparoscopic pelvic lymph node dissection (mean 17:8 versus 9.3). The overall positivity rate was 23 of 189 lymph nodes (12.2%), including 14 of 150 (7.3%) for modified and 9 of 39 (23.1%) for extended dissection (p = 0.02). Two patients (22%) who underwent extended dissection had positive lymph nodes in the external iliac area. Patients who presented with the high risk features of prostate specific antigen (PSA) greater than 20 ng./ml., Gleason score 7 or greater, or stage T2b disease or greater had a 26.5% (p = 0.0002), 22% (p = 0.0006) or 16.4% (p = 0.003) likelihood of positive lymph nodes, respectively. For extended versus modified laparoscopic pelvic lymph node dissection node positivity in high risk patients was 27% versus 18.8% (p = 0.4), 30 versus 26.4% (p = 0.8) and 25.4 versus 14.6% (p = 0.17) for Gleason score 7 or greater, PSA greater than 20 ng./ml. and disease stage T2b to T3a, respectively. Patients who underwent the extended procedure had a higher complication rate (35.9 versus 2%, p < 0.0001). No laparotomy was required. CONCLUSIONS: Despite yielding a 2-fold higher node count and higher node positivity rate, extended laparoscopic pelvic lymph node dissection offers no advantage over modified laparoscopic pelvic lymph node dissection for diagnosing positive lymph nodes when results are analyzed by prognostic factors. The extended procedure is associated with a much higher complication rate. In patients with the high risk features of PSA greater than 20 ng./ml., Gleason score 7 or greater and stage T2b to T3a disease modified laparoscopic pelvic lymph node dissection can be performed safely and effectively to help identify those who may benefit most from curative therapy.

Aged↗
PubMed1996

Prostate specific antigen findings and biopsy results following interactive ultrasound guided transperineal brachytherapy for early stage prostate carcinoma.

BACKGROUND: Interactive, transrectal, ultrasound-guided transperineal implantation is a new technique for performing permanent brachytherapy implants of the prostate. Prostate specific antigen (PSA) findings, biopsy results, and morbidity are examined to demonstrate its efficacy and safety in treating early stage prostate carcinoma. METHODS: Ninety-seven patients underwent permanent implants for classifications T1 to T2 adenocarcinoma of the prostate gland with a median follow-up of 18 months (range: 6-51 months). Seventy-nine patients had negative laparoscopic pelvic lymph node dissections prior to implantation. Patients with positive lymph nodes were not implanted. The radioactive isotope used was I-125 in 71 patients and Pd-103 in 26 patients. RESULTS: PSA failure was defined as two consecutive increases in PSA above the nadir level. The actuarial freedom from PSA failure (FFPF) at 2 years was 76% for the entire group. Stage significantly affected FFPF. Patients classified as T1b to T2a (35) had a FFPF of 91% at 2 years compared with 68.5% for patients classified as T2b to T2c (62) (P = 0.04). The pre-treatment PSA also significantly affected FFPF. Patients with PSA values of < or = 10 ng/mL (44) had a FFPF of 83% at 2 years. A similar rate of 82% was found in patients with PSA values of 10.1 to 20 ng/mL (29). Patients with PSA values > 20 ng/mL (24) had a significantly poorer FFPF at 2 years of 58% (P = 0.02). The PSA values of patients free from a PSA failure (82) ranged from 0.1 to 12.9 ng/mL with a median of 0.8 ng/mL. Transrectal prostate biopsies were performed 18 to 36 months posttreatment in 39 patients. Negative biopsies were found in 74% (29/39) of cases. The procedure was associated with an actuarial preservation of erectile function rate and sexual potency at 2 years of 96% and 79%, respectively. There were no cases of urinary incontinence or radiation cystitis. Associated morbidity included urinary retention requiring catheterization in 4% of the patients, outlet obstruction requiring a transurethral resection of the prostate in 2% and Grade 2 rectal complications in 1%. CONCLUSIONS: Interactive, ultrasound-guided transperineal brachytherapy results in a low PSA failure rate, high negative biopsy rate, and is associated with low morbidity and preservation of erectile function.

Adenocarcinoma↗
PubMed1996

Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer.

PURPOSE: The effect of a therapeutic modality on sexual potency is often an important consideration for patients choosing a treatment for prostate cancer. We prospectively assessed patients' penile erectile function before and following interactive ultrasound-guided transperineal permanent radioactive seed implantation to determine its effect on sexual function. METHODS AND MATERIALS: Eighty-nine patients underwent permanent radioactive seed implantation from June 1990 to April 1994 for localized prostate cancer (T1-T2) and were followed for a median of 15 months (1.5-52 months). 125I seeds were implanted in 73 patients with a combined Gleason grade of 2-6, and 103Pd seeds were implanted in 16 patients with higher grade lesions. The sexual potency of these patients was assessed prior to, at 3 and 6 months, and every 6 months after implantation. Erectile function was graded using a numerical score of 0 to 3 (0 = impotent (no erections), 1 = ability to have erections but insufficient for vaginal penetration, 2 = erectile function sufficient for vaginal penetration but suboptimal, 3 = normal erectile function). The pretreatment potency scores were as follows: 0 in 24 patients, 1 in 6 patients, 2 in 22 patients, and 3 in 37 patients. RESULTS: The actuarial impotency rates (score = 0) following implantation for those patients possessing some degree of erectile function prior to implantation (65 patients) were 2.5% at 1 year and 6% at 2 years. The actuarial decrease in sexual function rates (a drop in score of at least one point) were 29% at 1 year and 39% at 2 years. Only two patients became impotent following treatment and this occurred at 1 year and 16 months. The time period for a decrease in erectile function to occur ranged from 1.8 months to 32.7 months, with a median of 6.8 months. Patients with higher grade tumors showed a greater decrease in potency score compared to patients with lower grade tumors. CONCLUSION: Interactive ultrasound-guided transperineal brachytherapy for the treatment of localized prostate cancer is associated with preservation of erectile function in the vast majority of patients, although a minor decrease in potency is not uncommon.

Adenocarcinoma↗
PubMed1996

Seminal vesicle biopsy: accuracy and implications for staging of prostate cancer.

OBJECTIVES: Seminal vesicle biopsy (SVB) is a new technique for detecting the spread of prostate cancer to the seminal vesicles. A comparison of findings following SVB in patients undergoing radiation therapy with pathologic findings following radical retropubic prostatectomy (RRP) was made to evaluate the accuracy of this test and its use in the staging of prostate cancer. METHODS: Four hundred nine patients with clinically localized adenocarcinoma of the prostate gland were evaluated for treatment: 222 patients underwent SVB prior to radiation therapy and 187 patients underwent RRP. Clinical stages in patients undergoing SVB included T1a (1 patient), T1b (4), T1c (35), T2a (49), T2b (96), and T2c (37); RRP clinical stages included T1b (3 patients), T1c (48), T2a (57), T2b (66), and T2c (13). The Gleason scores in patients undergoing SVB were 2 to 4 in 50 men, 5 to 6 in 110 men, and 7 and greater in 62 men; the Gleason scores in patients undergoing RRP were 2 to 4 in 53 men, 5 to 6 in 94 men, and 7 and greater in 40 men. Prostate-specific antigen (PSA) values ranged from 1.3 to 190 ng/mL (median 10.75) in men undergoing SVB and ranged from 0.5 to 140.6 ng/mL (median 9.0) in men undergoing RRP. RESULTS: The overall incidence of seminal vesicle involvement as determined by the two techniques was the same. Seminal vesicle involvement was found in 33 of 222 patients (15%) undergoing SVB and in 27 of 187 (14%), of the RRP specimens (P = 0.9). When the two groups were further divided by three prognostic categories (clinical stage, PSA level, and grade), there was no difference in the incidence of seminal vesicle involvement between the two methods, except in the patients with Gleason score of 4 or less. In these patients, 5 of 53 (9%) had seminal vesicle involvement in the RRP group, compared with none of the 50 men in the SVB group (P = 0.02). Disease that was not organ confined was found in 69 of 187 prostatectomy specimens (37%). Of these patients, 27 of 69 (39%) had seminal vesicle involvement. CONCLUSIONS: SVB is an accurate method of detecting seminal vesicle invasion based on comparisons with radical prostatectomy findings. Its importance lies in its ability to detect a large percentage of patients with non-organ-confined disease and in its use in modifying treatment planning accordingly.

Adenocarcinoma↗
PubMed1996

CT findings after laparoscopic pelvic lymph node dissection and transperineal radioactive seed implantation for prostatic carcinoma.

OBJECTIVE: The purpose of this paper is to describe the CT findings in patients undergoing transperineal sonographically guided radioactive seed implantation with and without laparoscopic lymph node dissection for treatment of carcinoma of the prostate gland. MATERIALS AND METHODS: Ninety-six CT scans of the pelvis were retrospectively reviewed in patients who had undergone radioactive seed implantation of the prostate gland. The CT readings were correlated with the type of procedure each patient had and the pathologic results of laparoscopic lymph node dissection. RESULTS: Of 73 patients who underwent laparoscopic lymph node dissection, 42 were found at CT to have low-attenuation masses along lymph node chains. These masses resembled necrotic nodes. Only one patient who did not undergo laparoscopic lymph node dissection had similar findings. Fourteen patients had fluid collections within the pelvis, 13 of whom had undergone laparoscopic lymph node dissection. Other imaging findings included ectopic seeds (10 patients) and subcutaneous and intrapelvic air (11 patients). All except two patients had negative pathology reports for the removed lymph nodes. CONCLUSION: A wide variety of imaging findings may be seen after radioactive seed implantation and laparoscopic lymph node dissection, including masses that resemble necrotic lymph nodes. Radiologists should be aware of these findings in asymptomatic patients.

Brachytherapy↗
PubMed1995

Seminal vesicle biopsy and laparoscopic pelvic lymph node dissection: implications for patient selection in the radiotherapeutic management of prostate cancer.

PURPOSE: Seminal vesicle biopsies (SVB) and laparoscopic pelvic lymph node dissection (LPLND) are safe surgical staging procedures for prostate cancer that can yield more accurate information than can be obtained by routine clinical means. This information is critical in patient and treatment selection when planning definitive prostate irradiation. An analysis of the procedural findings was undertaken to better define those patients who might benefit from these procedures. METHODS AND MATERIALS: From June 1990 to February 1994, 120 patients with clinical Stage T1b to T2c prostate cancer with negative bone scan and pelvic computerized tomography (CT) scans underwent transrectal ultrasound guided SVB (three from each side). Of these patients, 99 also underwent LPLND. Twelve patients were excluded from analysis of LPLND findings because they were treated with 3 months of hormonal therapy prior to LPLND. During LPLND, 0 to 18 nodes were removed (median-five nodes) from the right side and 0 to 20 nodes (median-five nodes) were removed from the left side. Prostate specific antigen (PSA) values ranged from 1.6 to 190 ng/ml, with a median value of 11.5. Combined Gleason grades ranged from 2 to 9, with a median of 6. RESULTS: A positive SVB was found in 18 patients (15%). A logistic regression analysis was performed to test the effect of grade, PSA, and stage on SVB results. Combined grade and PSA were significant predictors of a positive SVB (p < 0.001 and p = 0.024, respectively). Patients with combined grades of 7 or greater had a higher positive SVB rate of 37.5% (12 out of 32) compared to 7% (6 out of 88) for patients with a lower grade (p < 0.0001). Patients with PSA values greater than 10 had a positive SVB rate of 21% (15 out of 70) compared to 6% (3 out of 50) for patients with values up to 10. There was no morbidity associated with SVB. Laparoscopic pelvic lymph node disection detected positive pelvic nodes in nine patients (10%). The effect of a positive SVB, combined Gleason grade, PSA, and stage on the detection of positive nodes were tested using a stepwise logistic regression analysis. Seminal vesicle biopsy was the most significant predictor of positive nodes (p < 0.0001), while combined grade and PSA were also significant predictors (p = 0.0006 and p = 0.005, respectively). Positive nodes were found in 50% (9 out of 18) of patients with positive SVB compared to 0% (0 out of 69) of patients with a negative SVB (p < 0.0001). Positive nodes were found in 35% (8 out of 23) of patients with a combined grade of 7 or greater compared to 2% (1 out of 64) of patients with a combined grade less than 7 (p < 0.0001). Laparoscopic pelvic lymph node dissection revealed positive nodes in 3% (2 out of 58) of patients with PSA levels < = 20 compared to 24% (7 out of 29) of patients with PSA levels greater than 20 (p = 0.003). Laparoscopic pelvic lymph node dissection was associated with a hospital stay of one night and a minor complication rate of 4%. There were no major complications. CONCLUSIONS: Seminal vesicle biopsy should be performed before treatment in all patients, except those with low risk factors, undergoing radiation therapy for prostate cancer, due to its ability to upstage patients, select patients for LPLND, and alter radiotherapeutic management. Laparoscopic pelvic lymph node dissection should be considered in patients with high risk features, especially in patients with positive SVB where the likelihood of encountering positive nodes is 50%.

Adenocarcinoma↗
PubMed1995

A modified technique allowing interactive ultrasound-guided three-dimensional transperineal prostate implantation.

PURPOSE: Ultrasound-guided transperineal prostate implantation is a new technique for performing permanent isotope implants of the prostate. The details of the technique are presented to demonstrate its ability to place radioactive seeds three-dimensionally within the prostate gland to achieve uniform dose distribution without the need for complicated preplanning. METHODS AND MATERIALS: An accurate measurement of the prostate volume is made using biplanar transrectal ultrasound. The total activity to be implanted is derived from a look-up table based on prostate volume. The basic plan is to implant 60-70% of the total activity in the periphery of the gland and the remaining activity in the interior of the gland. The ultrasound transducer provides visualization of the prostate through transverse, longitudinal and oblique cuts and allows for accurate placement of implant needles, approximately 1 cm apart. In addition, these needles can be moved through the prostate under constant visualization, thus allowing for precise seed placement. RESULTS: The setup of the transrectal ultrasound device as well as prostate volume measurements are performed in 10 to 15 min. The actual placement of the needles and seed implantation takes 1 to 1.5 h to perform. Postimplantation dosimetric evaluation is performed using orthogonal x-ray films and 3 mm thick CT slices taken at 3 mm intervals. This evaluation has confirmed accurate seed placement within the prostate gland. CONCLUSION: Interactive ultrasound guided transperineal prostate implantation is a fast and accurate method of performing permanent radioactive isotope prostate implants.

Brachytherapy↗
PubMed1995

Node-positive cervical cancer: impact of pelvic irradiation and patterns of failure.

PURPOSE: The roles of postoperative pelvic and prophylactic paraaortic irradiation in pelvic node positive cervical cancer are currently controversial. A retrospective study was undertaken to examine the effect of pelvic irradiation on pelvic control and survival and to analyze the patterns of recurrence to determine whether indications exist for prophylactic paraaortic irradiation. METHODS AND MATERIALS: From 1964 to 1991, 143 cases of FIGO Stage I and II cervical cancer undergoing exploratory laparotomy, pelvic lymph node dissection, and radical hysterectomy had positive pelvic lymph nodes. Postoperatively, 108 cases were treated with whole pelvic irradiation while 35 patients were observed. Prophylactic paraaortic irradiation was not given. RESULTS: Patients who received postoperative whole pelvic irradiation compared with those treated with radical hysterectomy alone had a significantly improved pelvic control rate, disease-free survival (DFS), and overall survival. The 5-year actuarial pelvic control rate was 78% vs. 45% (p = < 0.0001), respectively. The 5-year actuarial DFS was 65% vs. 41% (p = 0.0004). The 5-year actuarial overall survival was 58% vs. 46% (p = 0.02). In multivariate analysis, pelvic irradiation continued to show a positive effect on DFS (p = 0.0001) and overall survival (p = 0.0035). Lymphatic invasion and the total number of positive lymph nodes were the only other independent predictors of overall survival and DFS. The actuarial 5-year pelvic, paraaortic, and distant failure rates were 30%, 10%, and 28%, respectively. An isolated first recurrence in the paraaortic nodes occurred in only three cases. CONCLUSION: Postoperative pelvic irradiation significantly improves pelvic control, DFS, and overall survival, and should be used in patients with early stage cervical cancer and pathologically proven pelvic nodal metastases. The low incidence of isolated paraaortic nodal failure calls into question the value of routine prophylactic paraaortic irradiation in these patients.

Adult↗
PubMed1995

A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities.

This retrospective study of 100 cases of primary carcinoma of the vagina treated at Magee-Women's Hospital of the University of Pittsburgh from 1962 to 1992 analyzes disease and treatment-related prognostic factors and treatment results. Fifty percent of patients had previous hysterectomies prior to the diagnosis of vaginal cancer. The tumor was limited to one-third of the vaginal canal in 64 patients, but involved more than one-third of the canal in 36 patients. Treatment consisted of surgery in 40 patients, radiation therapy in 47 patients, and surgery plus radiation therapy in 13 patients. With a median follow-up of 11.2 years, the 5-year actuarial disease-free survival (DFS) was 67% for Stage I (23 patients), 53% for Stage II (58 patients), 0% for Stage III (9 patients), and 15% for Stage IV (10 patients). Using univariate and multivariate analysis, treatment with surgery, disease limited to one-third of the vaginal canal, and FIGO Stage I and II disease were significantly favorable prognostic factors for DFS. Treatment with surgery was superior to radiation therapy alone in Stage II patients (P = 0.00004). There appeared to be a selection bias in Stage II patients, as the more unfavorable cases were treated with radiation therapy. Although radiation therapy will often be the treatment of choice, excellent results and limited morbidity accompany selected cases surgically resected.

Adolescent↗
PubMed1995

Indications for seminal vesicle biopsy and laparoscopic pelvic lymph node dissection in men with localized carcinoma of the prostate.

PURPOSE: The ability of seminal vesicle biopsy and laparoscopic pelvic lymph node dissection to identify patients with stage T3 or N+ disease before undergoing treatment for localized carcinoma of the prostate was investigated. MATERIALS AND METHODS: A total of 157 patients with clinical stages T1a to T2c prostate cancer underwent ultrasound guided seminal vesicle biopsy (3 on each side) and 130 underwent subsequent laparoscopic pelvic lymph node dissection. RESULTS: Of 157 patients 23 (14.6%) had a positive seminal vesicle biopsy. Predictors of a positive seminal vesicle biopsy were stages T2b to T2c versus T1a to T2a disease (20% versus 4%, respectively, p = 0.005), Gleason score 7 or more versus less than 7 (34% versus 9%, respectively, p < 0.0001) and prostate specific antigen (PSA) 4 to 10 ng./ml., 10 to 20 ng./ml. or more than 20 ng./ml. (9%, 14% and 27%, respectively, p = 0.03). Of 130 patients 14 (10.7%) had a positive laparoscopic pelvic lymph node dissection. Predictors for a positive laparoscopic pelvic lymph node dissection were Gleason score 7 or more versus less than 7 (32% versus 2%, respectively, p < 0.0001), PSA more than 20 ng./ml. or less than 20 ng./ml. (24% versus 4.5%, respectively, p = 0.009) and stage T2b or T2c (15% and 24%, respectively, p = 0.056). Of the patients with a positive seminal vesicle biopsy 48% had a positive laparoscopic pelvic lymph node dissection (p < 0.0001). CONCLUSIONS: All patients with a Gleason score more than 4, PSA more than 10 ng./ml. or clinical stage T2b or more should undergo seminal vesicle biopsy, and those with a positive seminal vesicle biopsy or Gleason score 7 or greater should undergo laparoscopic pelvic lymph node dissection before initiating therapy for localized carcinoma of the prostate.

Aged↗
PubMed1995

Locoregional therapies for early-stage prostate cancer.

Widespread use of prostate-specific antigen (PSA) as a screening tool has led to an increased incidence of biopsy-proven prostate cancer, as well as a shift toward more cases with clinically confined disease (stage T1 to T2). The two traditional therapeutic modalities, radical prostatectomy and external-beam radiation therapy, have undergone technical refinements. Other modalities, such as brachytherapy and cryosurgery, are also being used to treat early-stage disease. Comparisons between treatment results are difficult. Biochemical failure, based on PSA findings, is currently used to measure treatment efficacy, but the precise definition and clinical relevance of biochemical failure have yet to be established. The author presents current analyses of biochemical failure, cause-specific survival, distant metastasis, and morbidity rates following various treatment modalities.

Combined Modality Therapy↗
PubMed1995

Brachytherapy for prostate cancer: real-time three-dimensional interactive seed implantation.

A total of 71 men with clinical T1b-T2c carcinoma of the prostate underwent ultrasound-guided interactive seed implantation of the prostate. Sixty received 125I and II 103Pd implants. A laparoscopic lymph node dissection was performed in 58 patients. The patients have been followed a mean of 2 years (1-4.2 years). With use of a prostate specific antigen (PSA) value of 1 ng/ml, patients (n = 8) who presented with an initial PSA of < or = 4.0 ng/ml were all free from failure. This compared with those who presented with an initial PSA of 4.1-10, 10.1-20, and > or = 20 ng/ml, in whom the freedom from failure rates were 52, 32, and 22%, respectively. Patients (n = 49) who presented with an initial PSA of less than or equal to 15 ng/ml had a median PSA of 0.88 ng/ml at last follow-up compared with 2.25 ng/ml for those with an initial PSA of > 15 ng/ml. Prostate biopsies performed 18-24 months after implantation were negative in 82%. The median PSA for those with a negative biopsy was 0.7 ng/ml vs. 4.9 ng/ml for those with a positive biopsy. There were no long-term persistent urinary complaints. Grade 2 radiation proctitis occurred in three (4.2%). No cases of severe radiation proctitis or cystitis occurred. Urinary retention occurred in four patients (5.6%), one of whom required a transurethral resection of the prostate. No patients developed urinary incontinence. Potency was preserved in 94%. We conclude that the real-time ultrasound-guided transperineal seed implantation technique is an effective and safe method of treating prostate cancer. Longer follow-up is needed to substantiate these early encouraging results.

Biopsy↗
PubMed1992

The importance of brachytherapy technique in the management of primary carcinoma of the vagina.

This retrospective analysis of 49 cases of primary carcinoma of the vagina treated with radiation therapy alone from 1970-1988 examines the results of treatment with an emphasis on the importance of brachytherapy technique. Thirty-six patients were treated with combined external beam radiation and brachytherapy, 11 patients were treated with external beam alone, and two patients were treated with brachytherapy alone. Brachytherapy techniques used included intracavitary implants, temporary Ir-192 interstitial implants, and permanent I-125 interstitial implants. Intracavitary therapy included the use of a fractionated high dose rate intravaginal cylinder, tandem and ovoids, and a low dose rate intravaginal cylinder. The 5-year actuarial survival was 44% for Stage I (six patients), 48% for Stage II (27 patients), 40% for Stage III (10 patients), and 0% for Stage IVa and IVb (six patients). There was a significant increase in the 5-year actuarial survival for those patients who had brachytherapy as part of their treatment compared to those patients treated with external beam alone (50% vs. 9%) (p < .001). For Stages II and III, there was a trend toward improved actuarial and crude disease free survival with the use of a temporary Ir-192 interstitial implant as part of the treatment compared to the use of intracavitary brachytherapy as part of the treatment (80% vs. 45%) (p = 0.25) and (75% vs. 44%) (p = 0.08), respectively. Brachytherapy plays an important role in the management of primary vaginal cancer. A temporary interstitial implant should be used over an intracavitary form of therapy for more invasive disease.

Adult↗
PubMed1988

Administrative ethics and conflicts of interest.

A great deal of healthcare management literature and an increasing amount of newspaper coverage are dealing with the subject of ethics. However, most of this attention is directed at clinical ethics. At the same time, the media have regularly covered alleged scandal or inappropriate behaviour by public officials in all walks of public life. Canadian healthcare executives will undoubtedly become more engrossed in the issue of ethics than ever before. It is both timely and essential for executives and their Boards to address these concerns squarely and develop ethically based policies and procedures for conflicts of interest.

Canada↗
PubMedDate not supplied

The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy.

The objectives of this study were to examine the effect of both disease and treatment related prognostic factors on biochemical control and post-treatment biopsy. Two-hundred fifty-eight patients underwent interactive ultrasound guided transperineal prostate implantation for T1-T2 prostate cancer using Iodine-125 (139 patients) and Palladium-103 (119 patients) and were followed from 6-67 months (median, 19). Hormonal therapy with 3 months of leuprolide and flutamide prior to implantation and two months given after the implant was used in 96 patients. Pre-treatment prostate-specific antigen (PSA) had the most significant effect on biochemical failure. Freedom from biochemical failure (FFBF) rates at 4 years were 75% for patients with PSA 1.3-10 ng/ml (144), 74% for patients with PSA 10.1-20 ng/ml (73), and 34% for patients with PSA > 20 ng/ml (41) (P = 0.0004). Gleason score also had a significant effect on FFBF rates. Four-year rates were 81%, 65% and 47% for patients with scores of 2-4 (68), 5-6 (130), and > or = 7 respectively (60) (P = 0.01). These two factors were also significant in multivariate analysis (P = 0.002, 0.007, respectively). Gleason score was the only factor to significantly affect post-treatment biopsy results. Patients with scores of 2-6 had 85% (63/ 74) negative 2-year biopsies versus 62% (13/21) for patients with scores > or = 7 (P = 0.02). Low-risk patients (PSA < or = 10 ng/ml, scores < 7 and stage < T2a) had a 4-year FFBF rate of 88% as compared to 60% for high-risk patients (PSA > 10 ng/ml, score > 6 or stage > or = T2b) (P = 0.02) and had a 95% negative biopsy rate versus 76% for high-risk patients (P = 0.06). Low-risk patients demonstrate high FFBF and negative biopsy rates following implantation. Patients presenting with higher risk prognostic factors such as PSA > 20 ng/ml or Gleason scores > or = 7 may require more aggressive treatment regimens.

Aged↗