The Influence of Prostate Volume on Outcome After High-Dose-Rate Brachytherapy Alone for Localized Prostate Cancer

Le, Hien; Rojas, Ana M.; Alonzi, R.; Hughes, Robert J.; Ostler, Peter; Lowe, Gerry; Bryant, Linda; Hoskin, Peter

doi:10.1016/j.ijrobp.2013.05.022

Cited by 19 publications

(8 citation statements)

References 25 publications

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“…In addition, genitourinary and gastrointestinal toxicity in patients with prostates > 50 mL was consistent with previously-reported toxicity for small prostates ( 6 , 16 ). Le et al ( 17 ) performed a study of 164 prostate cancer patients who underwent HDR brachytherapy monotherapy and found no significant difference in prostate D90 or V100 with prostate volumes > 50 mL. In patients with larger glands, a significantly higher biochemical control of disease was observed, with no difference in late toxicity.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

et al. 2015

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PurposeTo evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes.Materials and MethodsOne hundred and two prostate cancer patients with prostate volumes >50 mL (range: 5-29 mL) were treated with high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) to 4,500 cGy in 25 daily fractions between 2009 and 2013. HDR brachytherapy monotherapy doses consisted of two 1,350-1,400 cGy fractions separated by 2-3 weeks, and HDR brachytherapy boost doses consisted of two 950-1,150 cGy fractions separated by 4 weeks. Twelve of 32 (38%) unfavorable intermediate risk, high risk, and very high risk patients received androgen deprivation therapy. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.ResultsMedian follow-up was 14 months. Dosimetric goals were achieved in over 90% of cases. Three of 102 (3%) patients developed Grade 2 acute proctitis. No variables were significantly associated with Grade 2 acute proctitis. Seventeen of 102 (17%) patients developed Grade 2 acute urinary retention. American Urological Association (AUA) symptom score was the only variable significantly associated with Grade 2 acute urinary retention (p=0.04). There was no ≥ Grade 3 acute toxicity.ConclusionsDosimetric coverage of the prostate and normal tissue sparing were adequate in patients with prostate volumes >50 mL. Higher pre-treatment AUA symptom scores increased the relative risk of Grade 2 acute urinary retention. However, the overall incidence of acute toxicity was acceptable in patients with large prostate volumes.

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Section: Discussionmentioning

confidence: 99%

Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

et al. 2015

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“…The preoperative factors are the PSA level (Potters et al 2008), Gleason score (Sylvester et al 2011), risk stratification (Taira et al 2010), PPC (Taira et al 2011) and prostate volume (Le et al 2013). The operative factors are therapeutic radiation dose (Stone et al 2005) and the proficiency of implantation (Zelefsky et al 2007), and the postoperative factor is combination with ADT (Marshall et al 2014) or EBRT (Davis et al 2012).…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of early stage prostate cancer treated with brachytherapy analysis after a mean follow-up of 7 years

et al. 2014

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PurposeTo investigate the long-term efficacy of 125I brachytherapy in early-stage prostate cancer and to identify correlating factors.MethodsThis study included 117 cases of early stage prostate cancer. The patients ranged in age from 51 to 84 years, with a mean of 73 years. The features of the study population were as follows: the PSA ranged from 0.4 to 47.6 ng/ml (median, 14.7); the Gleason score ranged from 4 to 9 (mean, 6.4); the clinical stage ranged from T1b to T2c; and the positive biopsy rate ranged from 0.08 to 1.0 (mean, 0.45). The mean D90 was 142 Gy and ranged from 106 Gy to 170 Gy. The numbers of low-risk, intermediate-risk and high-risk prostate cancer cases were 22, 29 and 66, respectively. The biochemical no evidence of disease (bNED) rate and overall survival were recorded. Factors that correlated with the outcomes were evaluated.ResultsWith a mean follow up of 84 months, 33 cases had biochemical recurrence, with a bNED rate of 72%. The overall survival rate was 90%, and the cancer-specific survival rate was 97%. The bNED rates in the low-risk, intermediate-risk and high-risk groups were 86%, 79% and 64%, respectively (P = 0.040). The patients with PSA <20 ng/ml, a positive biopsy rate lower than 0.5, and D90 ≥ 140 Gy had lower biochemical recurrence (P = 0.028, 0.006, 0.009, respectively).ConclusionsThe long-term efficacy of 125I brachytherapy in early stage prostate cancer was shown. bNED is related to risk stratification, PSA level, positive biopsy rate and D90.

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“…Brachytherapy is an alternative therapeutic option for patients who desire a shortened course of treatment. However, brachytherapy may not be appropriate for all patients with an increased risk of urinary morbidity in men with a prior TURP, large prostate size (>50 cc), or high baseline lower urinary tract symptoms (IPSS ≥ 15) (7)(8)(9)(10)(11)(12)(13)(14)(15). The relationship between late urinary morbidity and high baseline IPSS has been extensively reported for brachytherapy with some studies reporting acceptable late toxicity in patients with high pretreatment IPSS (9,16).…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer in Men With a High Baseline International Prostate Symptom Score (IPSS ≥ 15)

et al. 2020

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Background: Patients with a high pretreatment IPSS may have higher rates of late urinary morbidity after radiation therapy for prostate cancer (1). Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation, which may be radiobiologically favorable to the conventional low-dose external beam fractions. The urinary toxicity associated with SBRT, however, remains unclear in patients with a high IPSS (1). We report our experience using SBRT for localized prostate cancer in patients with pretreatment IPSS ≥ 15. Methods: Localized prostate cancer patients with a pre-treatment IPSS ≥ 15 treated with SBRT at Georgetown University Hospital from 2009 to 2016 were included in this retrospective review of prospectively collected data. These patients were treated to 35-36.25 Gy in five fractions delivered via CyberKnife (Accuray Inc., Sunnyvale, CA). Urinary toxicity was assessed using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4). Urinary quality of life was assessed using validated questionnaires (IPSS and EPIC-26). Results: 53 patients at a median age of 71 years (range 57-89 years) received SBRT with a minimum follow up of 3 years. The median prostate size was 37 cm 3 (range 12-100 cm 3) and 30.2% patients received ADT. The 3-years incidence rate of Grade 3 urinary toxicity was 7.5% with median time to toxicity of 2.9 years. There were no Grade 4 or 5 toxicities. A mean baseline IPSS score of 19.8 significantly decreased to 12.9 at 3 months post-SBRT (p = 0.002) and remained stable at 36 months (13.7). A mean baseline EPIC-26 obstructive/irritative score of 64.1 significantly improved to 80.2 at 3 months (p = 0.002). This improvement was maintained to 36 months. There was no significant change from the mean baseline EPIC-26 urinary incontinence score at any point during follow up. Aghdam et al. High IPSS Score and SBRT Conclusions: SBRT for clinically localized prostate cancer was well-tolerated in men with baseline IPSS ≥ 15 (1). Grade 3 toxicities occurred but resolved with time. Our data suggest that poor baseline urinary function does not worsen following SBRT and may even improve. High baseline IPSS score should not be considered a contraindication to SBRT.

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The Influence of Prostate Volume on Outcome After High-Dose-Rate Brachytherapy Alone for Localized Prostate Cancer

Cited by 19 publications

References 25 publications

Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

Long-term outcome of early stage prostate cancer treated with brachytherapy analysis after a mean follow-up of 7 years

Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer in Men With a High Baseline International Prostate Symptom Score (IPSS ≥ 15)

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