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Follow-up Study of One Hundred Cases of Carcinoma of the Prostate Treated with Radioactive Gold

1955; Radiological Society of North America; Volume: 64; Issue: 5 Linguagem: Inglês

10.1148/64.5.637

1527-1315

H. Dabney Kerr, R.H. Flocks, H.B. Elkins, David A. Culp, Tom Evans,

Radiopharmaceutical Chemistry and Applications

In previous papers we have reported our experience in the treatment with radioactive gold of moderately advanced carcinoma of the prostate where local extension made radical surgery of little avail and where distant metastases could not be demonstrated. We emphasized that for this type of treatment it was important to select the patients carefully. This careful selection has remained essentially unchanged in all subsequent work. Patients with lesions which were definitely operable (Group I) have been reserved for radical surgical approach, while those with distant metastases or widespread primary lesions (Group III) have been treated by conservative palliative therapy. The importance of collaboration between the urologist and radiologist in the carrying out of this treatment was also emphasized. The work was undertaken in an effort to salvage some of those patients who would otherwise be treated only palliatively and symptomatically by the use of hormones, orchiectomy, and limited surgical procedures. From 40 to 60 per cent of all cases fall in this group. The object of this report is to present a series of 100 cases treated by combined interstitial injection of radioactive gold and surgery and analyzed as of June 1, 1953, and again as of June 1, 1954. All the patients, therefore, have been observed for a period of at least two years, and some for as long as thirty-nine months. An additional group of 52 cases has been under observation for a shorter period, one to two years. We are, of course, cognizant of the fact that many carcinomas of the prostate are slowly growing lesions, and our own studies indicate that without any definitive treatment directed toward cure, approximately 10 per cent of the patients will survive for five years. All of them, however, will have carcinoma at the time of death. In all of the cases which we are reporting, retropubic exploration was done, with microscopic proof of the neoplasm and determination of the gross extent of the primary lesion as well as the presence or absence of metastatic nodes. As has been emphasized by many writers, including ourselves, the use of radiation of a penetrating nature, such as high-voltage roentgen or gamma radiation, in the treatment of carcinoma of the prostate is fraught with difficulties because of the adjacent normal tissue, particularly bladder and rectum. Radioactive gold, therefore, which has a large component of beta radiation and a relatively short half-life—2.7 days-seemed an excellent material with which to start an experimental series of cases. The prostate also appeared to be an ideal organ for this purpose, inasmuch as there are many septal compartments in the gland which tend to localize the material to the site of injection.