Five hundred and forty-two patients have been treated for prostatic carcinoma with radiotherapy between 1965 and 1976 at our institution. All patients have been followed for longer than one year. Two hundred and ninety-five patients have been subjected to surgical exploration to document the precise stage of their disease and undergone staging pelvic lymphadenectomy at the time of interstitial implantation of radioactive gold grains. Postoperatively, these patients have received an average of 4500 rad, given over one month, external beam radiotherapy to the prostate. Excellent survival data are presented including the results of post treatment needle biopsy in a selected number of patients.

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Advances in imaging technology and implant technique have led to the resurgent interest and practice of brachytherapy for the treatment of prostate cancer. Brachytherapy is a form of radiation treatment in which radioactive sources are placed directly into the tumor; it offers the advantage of maximizing the radiation dose delivered to the tumor while sparing the adjacent normal tissue. Permanent implants have become an important component of radiation delivery. Interstitial gold radioisotope (Au‐198) implants for prostate cancer were introduced at Baylor College of Medicine in 1965. The rationale for using Au‐198, instead of the two most commonly used radioisotopes, Palladium‐103 (Pd‐103) and Iodine‐125 (I‐125), is discussed, and the Baylor implant technique is compared to that used in other centers. Retrospective review divides the patient population into pre‐ultrasound versus post‐ultrasound eras. Dosimetric calculation and disease control with the Au‐198 seed implant for prostatic cancer are reviewed for the two different eras; toxicity is evaluated in the post‐ultrasound era only. In the pre‐ultrasound era, 510 patients were treated with pelvic lymph node sampling and gold seed insertion of the prostate followed by external beam radiation. In the post‐ultrasound era, 54 patients were treated definitively with ultrasound‐guided transperineal Au‐198 implant followed by external beam irradiation. A small group of 30 patients in the post‐ultrasound era were evaluated for the efficacy of Au‐198 re‐implantation for locally recurrent disease. Semin. Surg. Oncol. 13:406‐418, 1997. © 1997 Wiley‐Liss, Inc.