Objective To evaluate the clinical efficacy of combined 125I brachytherapy and intermittent androgen deprivation for locally mediate-high risk prostate cancer.Methods A total of 25 patients with prostate cancer ranging from 64 to 85 years old (average age of 75) were recruited. The PSA level of these patients was 10.3～354.8 ng/mL, and the Gleason score was 7～9. All patients were clinically staged as T2～T3N0M0. Under continual epidural anesthesia in the lithotomy position, these patients underwent transrectal ultrasound scans from the basement of the prostate to the apex. Pictures were transmitted to the computer system to undergo three-dimensional reconstruction of the prostate and intra-operational planning. According to the plan, patients received 125I brachytherapy under the guidance of the transrectal ultrasound. All patients underwent maximal androgen blockage (MAB) therapy after surgery. Treatment was stopped when PSA fell to 0 ng/mL and stabilized for 2 months. The criterion for the resumption of hormonal therapy was a continuously increasing PSA level as detected in 3 consecutive tests. Results All 25 patients completed the surgery without complications. The number of implanted seeds was 85～110, with an average of 93. The follow-up period was 8～20 months, with an average of 12 months. One case was diagnosed with bone metastasis 10 months after the surgery. Within the 3 to 6 months after surgery, all the PSA levels fell below the normal level. Ten cases did not reach 0 ng/mL, so they continued the hormonal therapy. Five cases had increasing PSA levels 5～16 months after surgery, so MAB was restarted. After that, the PSA levels decreased to 0 ng/mL within 3～6 months. Two cases changed into hormone independent prostate cancer and bone metastasis occurred in these patients. At the end of the follow up period, the remaining 17 patients' PSA level was 0～1.2 ng/mL, and 10 patients of them had a PSA level less than 0.2 ng/mL. Early complications included mild to moderate urethral irritation (24%, 6/25), acute urine retention (8%, 2/25) and rectal irritation or bloody stool (16%, 4/25). Conclusions The combination of intermittent androgen deprivation and 125I brachytherapy is an effective and safe treatment for locally advanced prostate cancer.
