Feasibility and early toxicity of focal or partial brachytherapy in prostate cancer patients

Abstract

Purpose The aim of this study was to compare short-term oncologic outcomes and toxicity of focal or partial low-dose-rate brachytherapy (focal/partial LDR-BT) with whole gland low-dose-rate brachytherapy (whole LDR-BT) in localized prostate cancer patients. Material and methods Medical records of eligible patients who underwent focal/partial LDR-BT and whole LDR-BT between 2015 and 2017 at our institution were reviewed retrospectively. Clinical characteristics and pathologic outcomes were compared between focal/partial LDR-BT group and whole LDR-BT group. Biochemical recurrence-free survival was analyzed using Kaplan-Meier method and difference between two groups was assessed with log-rank test. Genitourinary and rectal toxicity were also evaluated between the two groups. Results Of the 60 patients analyzed, 30 focal/partial LDR-BT patients and 30 whole LDR-BT brachytherapy patients were included. Relative to the whole LDR-BT group, the focal/partial LDR-BT group had significantly higher initial PSA level ( p = 0.002), smaller number of implanted seeds ( p < 0.001), and shorter follow-up duration ( p < 0.001). There was no significant difference between the two groups with regard to prostate volume, biopsy Gleason score, and risk group stratification. The 3-year biochemical recurrence-free survival estimates for focal/partial LDR-BT group and whole LDR-BT group were 91.8% and 89.6%, respectively, which was not significantly different ( p = 0.554). Genitourinary symptoms were significantly worse in whole LDR-BT group than in focal/partial LDR-BT group. The incidence of rectal toxicity was similar between two groups. Conclusions Our findings indicate that the focal/partial LDR-BT is comparable to the whole LDR-BT with respect to short-term biochemical recurrence and toxicities.

Clinical Efficacy and Openness to New Challenges of Low Dose Rate Brachytherapy for Prostate Cancer

“…Only one patient showed PSA recurrence, for which radical prostatectomy was performed [49]. The other report showed less genitourinary toxicity in the focal brachytherapy group than in the whole prostate LDR brachytherapy group [46]. Considering these observations, focal brachytherapy is feasible, with good clinical outcomes and low toxicity.…”

“…Recently, focal low dose rate (LDR) brachytherapy has been reported for localized PCa [45,46]. Minh-Hanh et al demonstrated satisfactory five-year biochemical relapse-free, disease-free, and overall survival rates of 96.8%, 79.5%, and 100%, respectively.…”

Clinical Efficacy and Openness to New Challenges of Low Dose Rate (LDR) Brachytherapy for Prostate Cancer

“…Focal LDR brachytherapy for localized PCa has recently been reported. (35) (36) Minh-Hanh et al demonstrated satisfactory 5-year biochemical relapse-free, disease-free, and overall survival rates of 96.8%, 79.5%, and 100%, respectively. However, one limitation of the study is that only patients with low-to-intermediate risk PCa were included.…”

“…(39) The other report showed less genitourinary toxicity in the focal brachytherapy group than in the whole prostate LDR brachytherapy group. (35) Considering these observations, focal brachytherapy is feasible, with good clinical outcomes and less toxicity. Regarding the new generation PCa imaging methods, prostate-specific membrane antigen (PSMA) scans using positron emitters such as gallium-68 (Ga), copper-64 (Cu), and fluorine-18 (F) measured with positron emission tomography (PET) could detect PCa lesions more precisely.…”