title: Long term results of HDR brachytherapy in men older than 75 with localized carcinoma of the prostate.
abstract: BACKGROUND
  Prostate cancer is an illness with a high incidence, especially among older men. The choice of a treatment option among men above 75 years is, however, not clear. Radical prostatectomy in this age group is connected with a relatively high morbidity. A further possibility of curative treatment is radiotherapy which can be administered in the form of external beam or in combination with high dose rate (HDR) brachytherapy.
  
  
  OBJECTIVE
  The aim of our work was to evaluate how HDR brachytherapy is tolerated among men older than 75 and how associated diseases can influence the tolerance to this treatment. Of interest to us were the treatment results and mortality from other diseases.
  
  
  METHODS
  We analyzed a sample of 20 men above 75 years old (median 77 years) who were undergoing treatment by a combination of external radiotherapy and brachytherapy. Sixteen (80%) of them had prostate cancer with an intermediate and high risk of recurrence, four had low risk prostate cancer. Most patients, 14 (70%), had less than two comorbidities.
  
  
  RESULTS
  The median observation period was 57 months. No perioperative complications were recorded. Acute genitourinary toxicity (GU) to a maximum grade of 1-2 manifested in 60% of cases. Acute gastrointestinal toxicity (GIT) was observed only at grade 1 and in 25% of cases. Late GU toxicity occurred in 35% of patients, with only one showing grade 3; late GIT toxicity was recorded at grade 1 only in 3 patients (15%). 70% of the men lived longer than 3 years after treatment, at present, 50% lived more than 5 years. Long-term biochemical remission was achieved in 18 patients (90%).
  
  
  CONCLUSIONS
  HDR BRT is possible and well-tolerated in older men above 75 years in good condition and without serious intercurrence. Well-selected older patients with higher-risk tumours and without serious comorbidities undoubtedly benefit from radical treatment when compared with watchful waiting.
authors.affiliation: Cancer Centre, Department of Radiotherapy and Oncology, Nový Jičín, Czech Republic ; Medical Faculty, Ostrava University, Czech Republic.
authors.forename: Renata
authors.initials: R
authors.lastname: Soumarová
authors.affiliation: Cancer Centre, Department of Radiotherapy and Oncology, Nový Jičín, Czech Republic.
authors.forename: Luboš
authors.initials: L
authors.lastname: Homola
authors.affiliation: Cancer Centre, Department of Radiotherapy and Oncology, Nový Jičín, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Perková
keywords: High dose rate (HDR) brachytherapy; Localized prostate cancer; Older man