title: The results of real-time brachytherapy for the management of low- and intermediate-risk prostate cancer in patients with prostate volumes up to 100 mL.
abstract: OBJECTIVE
  • To report the results of real-time brachytherapy in the management of low-risk and intermediate-risk prostate cancer in patients with prostate volumes up to 100 mL, over a 6-year period. • To prospectively determine whether prostate volume influences the ability to achieve a quality implant and therefore impact upon prostate-specific antigen (PSA) relapse-free survival, and urinary and rectal toxicity.
  
  
  METHODS
  • In all, 216 men with localized prostate cancer were treated with real-time prostate brachytherapy using (125) I implants between November 2003 and December 2009. • Patient selection was based upon functional parameters; International Prostate Symptom Score (IPSS) and flowmetry. • Patients had computed tomography imaging at 1 month to assess post-implant dosimetry. PSA, IPSS and Radiation Therapy Oncology Group rectal toxicity scores were recorded prospectively over the follow-up period. • Patients with prostate volumes ≤50 mL and those with volumes >50 mL were compared.
  
  
  RESULTS
  • Overall PSA relapse-free survival was 98.8%; 97.0% for intermediate-risk patients and 100.0% for low-risk patients. By volume, 98.5% of men with standard prostates were free from PSA relapse compared with 100.0% of men with large prostates. • The mean post-implant D90 was 177.0 Gy; 175.5 Gy in standard prostates and 183.5 Gy in large prostates. • The overall acute urinary retention rate was 1.9%; 1.7% in standard prostates and 2.4% in large prostates. There were three urethral strictures, all in the standard prostate group. The mean IPSS increased to 11 and 14 at 3 months for the standard and large prostate groups, respectively, before settling to 2 above baseline for both groups at 12 months. • There were no rectovesical fistulae. Persistent rectal bleeding was reported by one (0.5%) patient in the standard prostate group.
  
  
  CONCLUSIONS
  • Prostate brachytherapy is effective in the treatment of low-risk and intermediate-risk prostate cancer. • It is technically possible to deliver a quality implant in a large prostate using real-time brachytherapy. • The treatment itself is well tolerated. Prostate volumes up to 100 mL should not exclude patients from brachytherapy providing either flow rate ≥14 mL/s or symptom score (IPSS) ≤ 10.
authors.affiliation: Berkshire Cancer Centre, Royal Berkshire NHS Foundation Trust, Reading, UK.
authors.forename: Nicola L
authors.initials: NL
authors.lastname: Dallas
authors.forename: Peter R
authors.initials: PR
authors.lastname: Malone
authors.forename: Adam
authors.initials: A
authors.lastname: Jones
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Doggart
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: McConway
authors.forename: Paul B
authors.initials: PB
authors.lastname: Rogers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012002:Rectal Diseases / Q000209:etiology; D012307:Risk Factors; D047368:Tumor Burden; D014525:Urethral Stricture / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen