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Stage II Prostate Cancer Treatment

    continued...

    3-dimensional (3D) conformal radiation therapy

    EBRT designed to decrease exposure of normal tissues using methods such as CT-based 3-D conformal treatment planning is under clinical evaluation.[32]

    Interstitial implantation of radioisotopes

    Interstitial implantation of radioisotopes (i.e., iodine-125 [125 I], palladium, and iridium), using a transperineal technique with either ultrasound or computed-tomography (CT) guidance, is being done in patients with T1 or T2a tumors. Short-term results in these patients are similar to those for radical prostatectomy or EBRT.[33,34]; [35][Level of evidence: 3iiiDiv]

    Factors for consideration in the use of interstitial implants include the following:

    • The implant is performed as outpatient surgery.
    • The rate of maintenance of sexual potency with interstitial implants has been reported to be 86% to 92%.[33,35] In contrast, rates of maintenance of sexual potency with radical prostatectomy were 10% to 40% and 40% to 60% with EBRT.
    • Typical side effects from interstitial implants that are seen in most patients but subside with time include urinary tract frequency, urgency, and less commonly, urinary retention.
    • Rectal ulceration may also be seen.[33] In one series, a 10% 2-year actuarial genitourinary grade 2 complication rate and a 12% risk of rectal ulceration were seen. This risk decreased with increased operator experience and modification of the implant technique.[36]

    Long-term follow-up of these patients is necessary to assess treatment efficacy and side effects.

    Retropubic freehand implantation with 125 I has been associated with an increased local failure and complication rate [36,37] and is now rarely done.

    Treatment Options Under Clinical Evaluation for Stage II Prostate Cancer

    Treatment options under clinical evaluation include the following:

    1. Ultrasound-guided percutaneous cryosurgery.
    2. High-intensity–focused ultrasound.
    3. Proton-beam radiation therapy.
    4. Other clinical trials.

    Ultrasound-guided percutaneous cryosurgery

    Cryosurgery is a surgical technique that involves destruction of prostate cancer cells by intermittent freezing of the prostate with cryoprobes followed by thawing.[38][Level of evidence: 3iiiC]; [39,40][Level of evidence: 3iiiDiv] Cryosurgery is less well established than standard prostatectomy, and long-term outcomes are not as well established as with prostatectomy or radiation therapy. Serious toxic effects include:

    • Bladder outlet injury.
    • Urinary incontinence.
    • Sexual impotence.
    • Rectal injury.
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