title: Dosimetric outcomes in prostate brachytherapy: is downsizing the prostate with androgen deprivation necessary?
abstract: OBJECTIVE
  A large prostate volume has historically been a relative contraindication to prostate brachytherapy (PB) because of concerns of toxicity and potential pubic arch interference. Common practice has been to downsize large prostates with androgen deprivation therapy (ADT) before proceeding with brachytherapy. The present study compares postimplant dosimetry in patients with prostate volumes >50 cc with those with prostate volumes </=50 cc.
  
  
  METHODS
  A review of all patients who underwent PB at our institution from 2001 to 2006 was performed. Postimplant dosimetry was obtained approximately 4 weeks after brachytherapy.
  
  
  RESULTS
  One-hundred forty-five out of a total of 148 patients had available dosimetry. In the 113 patients with prostate volumes </=50 cc (mean, 35.4 cc, range, 14.2-49.7 cc); the mean D(90) (dose which covers 90% of the prostate), V(100) (volume of prostate receiving 100% of the prescribed dose), V(150) (volume of prostate receiving 150% of the prescribed dose), and V(200) (volume of prostate receiving 200% of the prescribed dose) was 128.9%, 95.6%, 73.9%, and 51.2%, respectively. In the 32 patients with prostate volumes >50 cc (mean 58.1 cc, range 50.2-86.0 cc); the mean D(90), V(100), V(150), and V(200) was 125.1%, 95.2%, 68.2%, and 41.7%, respectively. The rectal V(100) was 1.0 cc for both cohorts. There was no statistically significant difference between the cohorts with respect to postimplant dosimetry for D(90), V(100), and V(150). The V(200) for prostate volumes >50 cc was significantly lower (p<0.05).
  
  
  CONCLUSIONS
  In the present study, patients with prostate volumes >50 cc have postimplant dosimetry parameters similar to patients with prostate volumes </=50 cc for D(90), V(100), and V(150); and significantly lower values for V(200). These results suggest that patients with large prostate volumes may not need to be routinely placed on hormonal therapy; sparing patients the side effects of hormonal therapy, and sparing the health care system the costs of luteinizing hormone-releasing hormone agonist injections.
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Urology at the University of Toronto, Toronto, Canada.
authors.forename: Erin P
authors.initials: EP
authors.lastname: Gibbons
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.forename: Komanduri
authors.initials: K
authors.lastname: Krishna
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Benoit
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D011467:Prostate / Q000033:anatomy & histology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen