Low-dose rate brachytherapy with I-125 seeds has an excellent 5-year outcome with few side effects in patients with low-risk prostate cancer

Rasmusson, Elisabeth; Gunnlaugsson, Adalsteinn; Kjellén, Elisabeth; Nilsson, Per; Einarsdóttír, Margrét; Wieslander, Elinore; Fransson, Per; Ahlgen, Göran; Blom, René

doi:10.1080/0284186x.2016.1175659

Cited by 13 publications

(8 citation statements)

References 26 publications

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“…SBRT delivered to 35–37.25 Gy in 5 fractions provides a BED of >198 Gy resulting in greater coverage of the CTV and a more conformal and homogeneic dose distribution compared to brachytherapy. Our 5-year bRFS for low- (98.5%) and intermediate-risk (95.5%) patients are comparable to those reported for high dose conventionally fractionated radiation therapy and low-dose brachytherapy (35–37). Further follow-up of PCa patients treated with SBRT will be required to confirm long-term cancer control suggested by its low PSA nadir.…”

Section: Discussionsupporting

confidence: 79%

Prostate-Specific Antigen 5 Years following Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: An Ablative Procedure?

et al. 2017

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BackgroundOur previous work on early PSA kinetics following prostate stereotactic body radiation therapy (SBRT) demonstrated that an initial rapid and then slow PSA decline may result in very low PSA nadirs. This retrospective study sought to evaluate the PSA nadir 5 years following SBRT for low- and intermediate-risk prostate cancer (PCa).Methods65 low- and 80 intermediate-risk PCa patients were treated definitively with SBRT to 35–37.5 Gy in 5 fractions at Georgetown University Hospital between January 2008 and October 2011. Patients who received androgen deprivation therapy were excluded from this study. Biochemical relapse was defined as a PSA rise >2 ng/ml above the nadir and analyzed using the Kaplan–Meier method. The PSA nadir was defined as the lowest PSA value prior to biochemical relapse or as the lowest value recorded during follow-up. Prostate ablation was defined as a PSA nadir <0.2 ng/ml. Univariate logistic regression analysis was used to evaluate relevant variables on the likelihood of achieving a PSA nadir <0.2 ng/ml.ResultsThe median age at the start of SBRT was 72 years. These patients had a median prostate volume of 36 cc with a median 25% of total cores involved. At a median follow-up of 5.6 years, 86 and 37% of patients achieved a PSA nadir ≤0.5 and <0.2 ng/ml, respectively. The median time to PSA nadir was 36 months. Two low and seven intermediate risk patients experienced a biochemical relapse. Regardless of the PSA outcome, the median PSA nadir for all patients was 0.2 ng/ml. The 5-year biochemical relapse free survival (bRFS) rate for low- and intermediate-risk patients was 98.5 and 95%, respectively. Initial PSA (p = 0.024) and a lower testosterone at the time of the PSA nadir (p = 0.049) were found to be significant predictors of achieving a PSA nadir <0.2 ng/ml.ConclusionSBRT for low- and intermediate-risk PCa is a convenient treatment option with low PSA nadirs and a high rate of early bRFS. Fewer than 40% of patients, however, achieved an ablative PSA nadir. Thus, the role of further dose escalation is an area of active investigation.

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Section: Discussionsupporting

confidence: 79%

Prostate-Specific Antigen 5 Years following Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: An Ablative Procedure?

et al. 2017

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“…Conversely, Rasmusson et al . [ 4 ] found a significant relationship between D 90 and biochemical failure-free survival, with 167 Gy considered as the tipping point. However, in our present case series, we did not stratify for arbitrary dose levels.…”

Section: Discussionmentioning

confidence: 99%

“…Several institutions have reported 5- and 10-year biochemical relapse-free survival ranging from 94-96% [ 2 , 3 , 4 ] to 87-98.5% [ 3 , 5 , 6 , 7 ], respectively. In addition, a number of reviews have demonstrated that LDR brachytherapy is equally effective as EBRT or radical prostatectomy (RP) alone in patients with newly diagnosed low- or intermediate-risk prostate cancer [ 8 , 9 , 10 ]; however, Rodrigues et al .…”

Section: Purposementioning

confidence: 99%

A single institution analysis of low-dose-rate brachytherapy: 5-year reported survival and late toxicity outcomes

Chao

Spencer

Guerrieri

et al. 2018

jcb

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PurposeTo report the 5-year biochemical relapse-free survival (BRFS), overall survival (OS), and long-term toxicity outcomes of patients treated with low-dose-rate (LDR) brachytherapy as monotherapy for low- to intermediate-risk prostate cancer.Material and methodsBetween 2004 and 2011, 371 patients were treated with LDR brachytherapy as monotherapy. Of these, 102 patients (27%) underwent transurethral resection of the prostate (TURP) prior to implantation. Follow-up was performed every 3 months for 12 months, then every 6 months over 4 years and included prostate specific antigen evaluation. The biochemical relapse-free survival (BRFS) was defined according to the Phoenix criteria. Acute and late toxicities were documented using the Common Terminology Criteria for Adverse Events version 4.0. The BRFS and OS estimates were calculated using Kaplan-Meier plots. Univariate and multivariate analyses were performed to evaluate outcomes by pre-treatment clinical prognostic factors and radiation dosimetry.ResultsThe median follow-up of all patients was 5.45 years. The 5-year BRFS and OS rates were 95% and 96%, respectively. The BRFS rates for patients with Gleason score (GS) > 7 and GS ≤ 6 were 96% and 91% respectively (p = 0.06). On univariate analysis, T1 and T2 staging, risk-group classification, and prostate volumes had no impact on survival at 5 years (p > 0.1). Late grade 2 and 3 genitourinary (GU) toxicities were observed in 10% and 5% of patients respectively. Additionally, patients with prior TURP had a greater incidence of late grade 2 or 3 urinary retention (p = 0.001). There were 14 deaths in total; however, none were attributed to prostate cancer.ConclusionsLDR brachytherapy is an effective treatment option in low- to intermediate-risk prostate cancer patients. We observed low biochemical relapse rates and minimal GU toxicities several years after treatment in patients with or without TURP. However, a small risk of urinary retention was observed in some patients.

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“…Given this situation, ED is an important morbidity factor for patients treated with PB. 3,4 Previous studies reported that ED occurred in 40-85% of patients treated with PB, and this wide range was attributed to differences in patient backgrounds, questionnaire scores in sexual function evaluations, surgical techniques and follow-up intervals. 5,6 To amend this discrepancy, we carried out a longitudinal prospective study to examine sexual function in patients receiving PB monotherapy without neo-or adjuvant hormone therapy using the IIEF-15.…”

Section: Introductionmentioning

confidence: 99%

Relationship between radiation doses and erectile function deterioration in patients with localized prostate cancer treated with permanent prostate brachytherapy

Shigeta

Kikuchi²,

Matsushima³

et al. 2020

Int J of Urology

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To investigate the relationship between radiation doses in prostate brachytherapy and deterioration of erectile function in patients with localized prostate cancer. Methods: A longitudinal survey study was carried out among 261 prostate cancer patients who received prostate brachytherapy. A total of 48 patients were potent at baseline and they did not receive any supplemental therapy preoperatively. Dosimetry parameters of the whole prostate gland, prostate apex, urethra and rectum were collected using the VariSeed 8.0 treatment planning system (Varian Medical Systems, Palo Alto, CA, USA). We carried out a logistic regression analysis to clarify the relationship between radiation doses and erectile function deterioration, which was assessed using the International Index of Erectile Function-15 questionnaire. Results: The median patient age was 66 years (range 53-70 years) with a median follow-up time of 44 months (36-71 months). The mean total International Index of Erectile Function-15 score decreased from 49.9 at baseline to 34.7 after 12 months (P < 0.001), but gradually plateaued within 36 months. Erectile function deterioration was noted in 32 (66.7%) patients 36 months after prostate brachytherapy. In an analysis of risk factors for erectile function deterioration after prostate brachytherapy, age ≥70 years (P = 0.029), prostate V100 ≥95% (P = 0.024), apex V100 ≥95% (P = 0.024), apex V150 ≥70% (P = 0.009) and apex D90 ≥150 Gy (P = 0.011) correlated with erectile function deterioration. A multivariate analysis identified an age of ≥70 years (odds ratio 7.91, P = 0.024) and apex V150 ≥70% (odds ratio 7.75, P = 0.007) as independent risk factors for erectile function deterioration after prostate brachytherapy. Conclusions: An excessive radiation dose, particularly to the prostate apex area, and an advanced age might have a negative impact on the preservation of potency after prostate brachytherapy.

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Low-dose rate brachytherapy with I-125 seeds has an excellent 5-year outcome with few side effects in patients with low-risk prostate cancer

Cited by 13 publications

References 26 publications

Prostate-Specific Antigen 5 Years following Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: An Ablative Procedure?

Prostate-Specific Antigen 5 Years following Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: An Ablative Procedure?

A single institution analysis of low-dose-rate brachytherapy: 5-year reported survival and late toxicity outcomes

Relationship between radiation doses and erectile function deterioration in patients with localized prostate cancer treated with permanent prostate brachytherapy

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