The effect of androgen deprivation on the early changes in prostate volume following transperineal ultrasound guided interstitial therapy for localized carcinoma of the prostate.
OBJECTIVE
To determine the change in volume of the prostate as a result of neoadjuvant androgen deprivation prior to prostate implant and in the early postimplant period following transperineal ultrasound guided palladium-103 brachytherapy for early-stage prostate cancer.


METHODS
Sixty-nine men received 3 to 6 months of androgen deprivation therapy followed by treatment planning ultrasound followed 4 to 8 weeks later by palladium-103 implant of the prostate. All patients had clinical and radiographic stage T1c-T2b adenocarcinoma of the prostate. A second ultrasound study was carried out 11 to 13 days following the implant to determine the change in volume of the prostate as a result of the implant. The prehormonal and preimplant volumes were compared to the postimplant volume to determine the effect of hormones and brachytherapy on prostate volume.


RESULTS
The median decrease in prostate volume as a result of androgen deprivation was 33% among the 54 patients with prostate volume determinations prior to hormonal therapy. The reduction in volume was greatest in the quartile of men with the largest initial gland volume (59%) and least in the quartile of men with smallest glands (10%). The median reduction in prostate volume between the treatment planning ultrasound and the follow-up study after implant was 3%, but 23 (33%) patients had an increase in prostate volume, including 16 (23%) who had an increase in volume >20%; 11 of these patients (16%) had an increase in volume >30%. The time course of development and resolution of this edema is not known. The severity of the edema was not related to initial or preimplant prostate volume or duration of hormonal therapy.


CONCLUSIONS
Prostate edema may significantly affect the dose delivered to the prostate following transperineal ultrasound guided brachytherapy. The effect on the actual delivered dose will be greater when shorter lived isotopes are used. It remains to be observed whether this edema will affect outcome.
Department of Radiation Oncology, The University of Pennsylvania, Philadelphia, USA.
R
R
Whittington
G A
GA
Broderick
P
P
Arger
S B
SB
Malkowicz
R D
RD
Epperson
B
B
Arjomandy
A
A
Kassaee
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D016729:Leuprolide / Q000627:therapeutic use; D008297:Male; D010165:Palladium / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D018084:Ultrasonography, Interventional
D018931:Antineoplastic Agents, Hormonal; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D017273:Goserelin; D010165:Palladium; D016729:Leuprolide