High-dose-rate (HDR) prostate brachytherapy uses volumetric imaging for treatment planning. Our institution transitioned from computed tomography (CT)-based planning to MRIbased planning with the hypothesis that improved visualization could reduce treatment-related toxicity. This study aimed to compare the patient-reported health-related quality of life (hrQOL) and physician-graded toxicity outcomes of CT-based and MRI-based HDR prostate brachytherapy. METHODS: From 2016 to 2019, 122 patients with low-or intermediate-risk prostate cancer were treated with HDR brachytherapy as monotherapy. Patients underwent CT only or CT and MRI imaging for treatment planning and were grouped per treatment planning imaging modality. Patientreported hrQOL in the genitourinary (GU), gastrointestinal (GI), and sexual domains was assessed using International Prostate Symptom Score and Expanded Prostate Cancer Index Composite Short Form-26 questionnaires. Baseline characteristics, changes in hrQOL scores, and physician-graded toxicities were compared between groups. RESULTS: The median follow-up was 18 months. Patient-reported GU, GI, and sexual scores worsened after treatment but returned toward baseline over time. The CT cohort had a lower baseline mean International Prostate Symptom Score (5.8 vs. 7.8, p 5 0.03). The other patient-reported GU and GI scores did not differ between groups. Overall, sexual scores were similar between the CT and MRI cohorts ( p 5 0.08) but favored the MRI cohort at later follow-up with a smaller decrease in Expanded Prostate Cancer Index Composite Short Form-26 sexual score from baseline at 18 months (4.9 vs. 19.8, p 5 0.05). Maximum physician-graded GU, GI, and sexual toxicity rates of grade $2 were 68%, 3%, and 53%, respectively, with no difference between the cohorts ( p 5 0.31). CONCLUSION: Our study shows that CT-and MRI-based HDR brachytherapy results in similar rates of GU and GI toxicity. MRI-based planning may result in improved erectile function recovery compared with CT-based planning. Published by Elsevier Inc. on behalf of American Brachytherapy Society.

At present, transurethral resection of bladder tumors (TURBT) is the main surgical method for treating non-muscle invasive bladder cancer (NMIBC), but its postoperative recurrence needs to be prevented. The aim of the present study was to investigate the efficacy of a 980-nm diode laser combined with preoperative intravesical instillation of pirarubicin (THP) for the prevention of NMIBC recurrence. The data of 120 patients with NMIBC who underwent transurethral resection between May 2021 and July 2022 were retrospectively collected, and these patients were followed up. The patients were divided into four groups based on the surgical method used and preoperative intravesical instillation of THP as follows: i) 980-nm diode laser with THP (LaT); ii) 980-nm diode laser alone (La); iii) TURBT with THP (TUT); and iv) TURBT alone (TU). Clinicopathological variables, postoperative complications and short-term outcomes among the aforementioned groups were analyzed. The blood loss volume and the incidence of perforation and delayed bleeding were significantly lower in the LaT and La groups compared with those in the TUT and TU groups. The days of bladder irrigation, catheter extubation and postoperative hospitalization were significantly shorter in the LaT and La groups compared with the TUT and TU groups. The detection rate of suspicious lesions was significantly higher in the THP irrigation groups (LaT and TUT) compared with that in the saline irrigation groups (La and TU). Tumor diameter and number, 980-nm laser and THP irrigation were shown to be independent risk factors in the Cox regression analysis. In addition, the recurrence-free survival (RFS) rate of the LaT group was significantly higher than that of the other three groups. In conclusion, a 980-nm diode laser can effectively reduce intraoperative blood loss and the incidence of perforation, and accelerate postoperative recovery. Preoperative intravesical instillation of THP is conducive to identifying suspicious lesions. The combination of a 980-nm laser with preoperative THP intravesical instillation can significantly prolong RFS time.

PSA kinetics post-brachytherapy are not well described. Our aim was to validate the Phoenix criterion (PC nadir+2) for BF in men treated with prostate brachytherapy without ADT, a definition initially established based on retrospective analysis of external beam radiotherapy data. Materials/Methods: Our dataset consisted of 9,219 patients from 3 countries who received l-125 or Pd-103 low dose rate prostate brachytherapy without ADT. First, to compare the performance of the different PC definitions, we applied ROC analysis to test the significance of the difference between AUC for PC nadir+2 and that for alternative PSA failure definitions (PSA> Z X after Y years of follow up, where X Z 1.5-4.0 and Y Z 0-1.5). Second, the Mann-Whitney rank-sum test was applied to test for any difference between the time to PC nadir+2 failure or time to alternative PSA failure definition, and time to clinical failure in cases where both a clinical failure and a PSA-predicted failure occurred. Results: 4,169 (45.2%), 4,665 (50.6%), and 385 (4.2%) of the patients without ADT were respectively low risk, intermediate risk, and high risk. Median follow up was 5.3 years. Alternative definitions of BF were not significantly superior to the PC nadir+2 (all p-values > 0.05). The times to clinical failure after biochemical failure were slightly but not significantly shorter for the PC nadir+2 definition (1.6 y) than for those using the bestperforming of the alternative definitions: PSA> Z 3 after 0.5 years follow up (1.84 y). Conclusion: Findings from an international cohort validate use of the nadir+2 PC for BF in men receiving definitive low dose rate prostate brachytherapy without androgen deprivation therapy for prostate cancer.