Having introduced modern, ultrasound-guided seed implantation to the US in the mid-1980’s, the physicians at SPI have been tracking the experience of their patients for more than 15 years.  Figure 5 shows the long-term, disease-free survival rates for our patients in the low, intermediate, and high risk groups. 

Figure 5. Seattle long-term biochemical relapse-free survival outcomes, stratified by D’Amico risk groups.

Sylvester J, Grimm P, Blasko J, et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy; Seattle Experience. Inter J Radiat Oncol Bio Phys 2006; 66:58s.

As might be expected, the low risk group has had the greatest success with an overall 85.8% survival rate at 15 years. Even the intermediate group has done very well with 80.3% of these patients remaining cancer free over the same time period. High-risk patients did well compared to others with high risk in that era with a 67.8% disease-free survival outcome.

Together with similarly encouraging long-term results that have been reported by other longstanding prostate brachytherapy centers, the experience of SPI has clearly established radioactive seed implantation to be at least as effective at controlling cancer as surgery and other conventional treatments. As a matter of fact, published studies indicate that high quality brachytherapy appears to be superior to surgery in more aggressive cancer (i.e. intermediate and high risk groups).  As further evidence of the widespread acceptance of seed implantation, it is now estimated that approximately one third of all men diagnosed with early stage prostate cancer are now being treated with brachytherapy.

The 15 year results of brachytherapy are excellent compared to other treatments that were given 15 years ago, despite the fact that the brachytherapy patients had worse pre-treatment prognosis due to significantly higher pre-treatment PSA’s, higher stage disease, slightly higher Gleason scores, and significantly longer follow-up.

Long Term Outcomes

Abbreviations: SPI= Seattle Prostate Institute; JHH-RP= Johns Hopkins Hospital- radical prostatectomy; WU-RP=Washington University radical prostatectomy; iPSA= initial prostate specific antigen; GS= Gleason score.

Modern era patients have even better success rates than these patients we treated many years ago, because modern patients usually have less bulky disease and are usually diagnosed earlier due to PSA screening being more common now than it was in the late 1980’s and early 1990’s.

Modern outcomes with seed implants are now better than previous results.  For example, Merrick and colleagues recently reported on a series of modern patients (treated from 1995-2001), using the Seattle technique developed by Doctors Peter Grimm, John Blasko and John Sylvester.  They published a relapse-free survival rate for low risk patients of 98.2%, intermediate risk patients 98.4% and high risk patients of 88.2%.  To date, no other treatment (surgery, cryosurgery, IMRT radiation therapy, proton beam therapy, cyberknife therapy or hormone therapy) has matched up to these results.

Quality of Life

With the growing medical consensus that prostate cancer patients with a favorable risk profile will do well in terms of cancer-free survival regardless of the type of treatment they select, clinical investigators have begun to focus their efforts on the developing field of quality-of-life (QOL) research. Rather than focusing on survival rates and complications, QOL research attempts to measure overall well-being, that is, how a given treatment effects a person's work, attitudes, relationships, recreation, normal bodily functions and the like.

As suggested above, QOL is relatively new area of research in the field of prostate cancer and the studies that have been done to date have been inconclusive. Much more work needs to be done to develop the tools and techniques that will yield the kind of information that can help physicians and their patients draw meaningful conclusions about the likely impact of various treatments on everyday living.