Interstitial radiation therapy for carcinoma of the prostate

Pelvic lymph node dissection and iodine 125 implantation has been systematically utilized at Memorial Sloan-Kettering Cancer Center (MSKCC) since 1970 as one form of management of selected patients with stage B or stage C prostatic cancer. Experience with the technique is reviewed on the basis of previously published data and on the basis of a five-year follow-up of the first 100 patients. The operative procedure has been generally well tolerated, with a low morbidity, with a mortality rate of 0.67% (2/300), and with minimal adverse effects on urinary, rectal, and sexual functions. Thirty-six percent of the patients had regional lymph node metastasis, and such was associated with a 71% incidence of distant metastasis at five years. However, at five years 14% of patients with positive nodes remain free of evidence of neoplasm, and 38% of patients with negative lymph nodes have evidence of bone metastasis. At five years, 11% of patients have evidence of local recurrence only; 19%, distant metastasis only; and 32%, both local recurrence and distant metastasis. Five-year survival without stratification relative to lymph node involvement is 100% (16/16) for stage B1, 88% (23/26) for stage B2, 66% (6/10) for stage B3, 33% (2/6) for stage C1, 53% (17/32) for stage C2, and 1/1 for stage C3, but endocrine therapy has presumably contributed to such survival in those patients developing intractable local recurrence and/or symptomatic distant metastasis within the five-year follow-up.