Prospective comparison of PSA kinetics following two different prostate cancer brachytherapy planning methods: preoperative and real-time intraoperative dosimetry planning.
OBJECTIVE
Preoperative planning (PP) and intraoperative planning (IoP) are established (125)I-brachytherapy techniques for the treatment of localized prostate cancer. We prospectively compared the effects of each method on reducing PSA levels.


METHODS
One hundred eighty patients treated with brachytherapy as monotherapy without neoadjuvant androgen deprivation therapy or external beam radiation using PP (75) or IoP (105) methodologies and with ≥ 5 years of follow-up were included in the study. CT-based dosimetry was calculated 1 month postoperatively. PSA was obtained every 3 months for the first year and semiannually thereafter. Available PSA and dosimetric data from both groups were analyzed and compared.


RESULTS
At 5 years after brachytherapy, the probability of having a nadir PSA value < 0.5 ng/ml was 90% in the IoP group compared with 60% in the PP group (P < 0.0001). The rate of PSA decline was 3-fold faster in the IoP group than in the PP group. Dosimetry results highly favored the IoP method: mean V(100) (%) and D(90) (Gy) were 95 and 180 vs. 60 and 81 (P < 0.001), respectively.


CONCLUSIONS
Our initial finding of highly superior postimplant CT dosimetry calculations of the IoP method are now substantiated by the biochemical favorable results (PSA kinetics) of this method.
Matzkin
Haim
H
Department of Urology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Chen
Juza
J
Stenger
Amira
A
Agai
Rubi
R
Mabjeesh
Nicola J
NJ
D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007700:Kinetics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D011874:Radiometry / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen