The development of prostate-specific antigen (PSA) and transrectal ultrasonography (TRUS) in the 1980s has led to both a surge in the absolute incidence of prostate carcinoma and to an increase in the proportion of early-stage disease diagnosed. Between 1986 and 1990 the incidence of prostate cancer in American men rose an average of 8.2% annually.<sup>26 Garfinkel L., Mushinski M. Cancer incidence, mortality and survival: Trends in four leading sites Stat Bull Metrop Insur Co 1994 ;  75 : 19

Cliccare qui per andare alla sezione Riferimenti</sup> In contrast, between 1975 and 1979 the age-adjusted incidence rate increased a mere 2.2% per annum.<sup>26 Garfinkel L., Mushinski M. Cancer incidence, mortality and survival: Trends in four leading sites Stat Bull Metrop Insur Co 1994 ;  75 : 19

Cliccare qui per andare alla sezione Riferimenti</sup> According to surveys by the American College of Surgeons Commission on Cancer, 43% of patients diagnosed in 1975 had advanced-stage disease; by 1990, this percentage had dropped to 33%.<sup>50 Mettlin C., Jones G.W., Murphy G.P. Trends in prostate cancer in the United States 1974–1990: Observations from the patient care evaluations studies of the American College of Surgeons Commission on Cancer CA Cancer J Clin 1993 ;  43 : 83  [cross-ref]

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The ultimate clinical significance of early-stage disease detected by PSA is currently a source of active debate with scientific, political, and economic overtones. Some authorities advocate an expectant management strategy for low-grade and stage tumors.<sup>21 Fleming C., Wasson J.H., Albertsen P.C. , e al. A decision analysis of alternative treatment strategies for clinically localized prostate cancer JAMA 1993 ;  269 : 2650

Cliccare qui per andare alla sezione Riferimenti, 37 Johansson J., Adami H., Andersson S. , e al. High 10-year survival rate in patients with early, untreated prostatic cancer JAMA 1992 ;  267 : 2191

Cliccare qui per andare alla sezione Riferimenti, 76 Talcott J.A., Rieker P., Propert K. , e al. Complications of treatment for early prostate cancer: A prospective, multi-institutional outcomes study [abstract] Proc Am Soc Clin Oncol 1994 ;  13 : A711 (abstr).

Cliccare qui per andare alla sezione Riferimenti</sup> Critics of aggressive treatment cite quality-of-life studies that demonstrate significant morbidity associated with radical prostatectomy or external beam irradiation.<sup>21 Fleming C., Wasson J.H., Albertsen P.C. , e al. A decision analysis of alternative treatment strategies for clinically localized prostate cancer JAMA 1993 ;  269 : 2650

Cliccare qui per andare alla sezione Riferimenti, 47 Litwin M.S. Health-related quality of life after treatment for localized prostate cancer Cancer 1995 ;  75 : 2000  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 76 Talcott J.A., Rieker P., Propert K. , e al. Complications of treatment for early prostate cancer: A prospective, multi-institutional outcomes study [abstract] Proc Am Soc Clin Oncol 1994 ;  13 : A711 (abstr).

Cliccare qui per andare alla sezione Riferimenti</sup> From these studies, it is questioned whether the treatment sequelae are justified by the uncertain survival benefit of definitive therapy for earlystage disease, particularly in older men.<sup>21 Fleming C., Wasson J.H., Albertsen P.C. , e al. A decision analysis of alternative treatment strategies for clinically localized prostate cancer JAMA 1993 ;  269 : 2650

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From this setting has emerged a renewed interest in relatively low-risk, curative therapies for carcinoma of the prostate. Brachytherapy, once abandoned as a treatment option, has again been posited as an alternative to prostatectomy or external beam irradiation.<sup>5 Blasko J.C., Grimm P.D., Ragde H. Brachytherapy and organ preservation in the management of carcinoma of the prostate Semin Radiat Oncol 1993 ;  3 : 240  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 58 Porter A.T., Blasko J.C., Grimm P.D. , e al. Brachytherapy for prostate cancer CA Cancer J Clin 1995 ;  45 : 165  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The rekindling of interest in brachytherapy has resulted not only from a demand for a more cost-effective, lower-morbidity treatment, but also from advancements in imaging technology, treatment planning software, and delivery apparatus that have culminated in a technique that appears exacting and reproducible. This article explores the technical underpinnings of contemporary brachytherapy and examines the current published data relating to the effectiveness and morbidity of this modality.