1. MINIMALLY INVASIVE URO-ONCOLOGICAL TREATMENTS ON THE AMBULATORY SETTING PROSTATE BRACHYTHERAPY I125
Luís Campos Pinheiro

2. PROSTATE BRACHYTHERAPY IS A MATURE TECHNIQUE
WELL ESTABLISHED AS A STANDARD LOCALISED PROSTATE CANCER TREATMENT
At least 14 Lisbon Centers:
British Hospital (2 teams)
Hospital da Luz
Clínica da Reboleira
Hospital S. Luís (2 teams)
Hospital das Descobertas
Clínica Europa (2 teams)
Hospital da Cruz Vermelha
Hospital Particular de Lisboa
IPO
Hospital Sta Maria
Hospital de S. José

3. PROSTATE BRACHYTHERAPY IS A MATURE TECHNIQUE
WELL ESTABLISHED AS A STANDARD LOCALISED PROSTATE CANCER TREATMENT
BRITISH HOSPITAL SINCE SEPTEMBER 2000
865 brachytherapy patients

4. PROSTATE BRACHYTHERAPY IS OPERATOR DEPENDENT
WHICH IS CLEARLY LINKED TO
SURGICAL EXPERIENCE
When performed by an experienced, high volume team the likelihood of inadequate implant (D90 less than 140) is less than 5%
British Hospital: 4/865 = 0.46%

5. PROSTATE BRACHYTHERAPY:
Low risk T1-T2 achieves low PSA Nadir and durable long term control
The 10 to 15 years biochemical survival is consistently in the 85% to 95% range
No evidence of late failures after 10 years %
Years
Stone (Mount Sinai) 88 12
Potters (NY Prostate Institute) 89
Sylvester (Seattle Prostate Institute) 86 15
Taira (University of Washington) 99

6. PROSTATE BRACHYTHERAPY FOR INTERMEDIATE AND HIGH RISK PCA
THE PERFECT DOSE ESCALATION
BED over 180 Gy is associated with positive biopsy rates of 3%
Intermediate Risk (%)
High Risk(%)
Years
Stone (Mount Sinai) 79 67 12
Potters (NY Prostate Institute) 78 63
Sylvester (Seattle Prostate Institute) 80 62 15
Taira (University of Washington) 97 91

9. 5-year bFFF for Gleason 8-10 by BED Gleason 8-10, PSA > 20 ng/ml
85.7%
BED > 220
220 Gy (86%)
71.6%
BED
< 220 Gy (61%)
24.4%
BED < 200
Very high doses:
BED > 220 Gy
I-125 (130 Gy) plus EBRT (45 Gy)

10. BRITISH HOSPITAL SERIES
LISBON SERIES
BRITISH HOSPITAL SERIES
Between September 2000 and November 2006
52 high risk prostate cancer patients
Iodine 125 prostate brchytherapy (110Gy)
EBRT (45 Gy) 2 months after
Hormonal therapy 3M plus 6M (LHRH analogue) 31/52 pt (59%)
High Risk definition:
Gleason Score 8 to 10; PSA above 20 ng/ml; T2c – T3
2 of (Gleason Score 7; PSA between 10 to 20; T2b)

11. BRITISH HOSPITAL SERIES
Dosimetric CT (1 month post brachytherapy): Mean D90 of Gy (Range 95 Gy to 162 Gy) Biological Equivalent Dose of 211,58 Gy (Range 183 to 256,5 Gy)

12. BRITISH HOSPITAL SERIES
The Actuarial Overall Freedom from PSA failure was 84.7% at 7 years

13. PROSTATE BRACHYTHERAPY IS AN ORGAN FUNCTION-SPARING TREATMENT
Long term erectile dysfunction and urinary incontinence are significantly lower after
brachytherapy compared to surgery

14. CONCLUSIONS
Prostate brachytherapy as evolved from a novel, minimally invasive treatment modality indicated only for the low risk prostate cancer
To a standard highly efficacy, low morbidity treatment to localized and locally advanced prostate cancer