Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution

Anderson, E; Smyth, LML; O&#39;Sullivan, R; Ryan, A; Lawrentschuk, N; Grummet, J; See, AW

Author(s): Anderson, E; Smyth, LML; O'Sullivan, R; Ryan, A; Lawrentschuk, N; Grummet, J; See, AW;
Details: Publication Year 2021-09,Volume 10,Issue #9,Page 3591-3603
Journal Title: Translational Andrology and Urology
Publication Type: Research article
Abstract: BACKGROUND: Focal treatment for prostate cancer (PCa) is a hybrid approach combining ablative treatment of the involved prostate gland and continued active surveillance (AS) of the unaffected gland. Low dose-rate (LDR) brachytherapy can be used as a lesion-targeted focal therapy, however, further studies are required to support its use. The aim of this study is to evaluate the dosimetry, toxicity and oncological outcomes of men receiving lesion-targeted focal LDR brachytherapy for low to intermediate risk PCa. METHODS: This is a retrospective cohort study of 26 men with unifocal, low to intermediate grade PCa diagnosed on a combination of multiparametric-magnetic resonance imaging (mp-MRI) and targeted plus template transperineal (TP) biopsy, who received focal LDR brachytherapy at a single institution. Brachytherapy involved a single monotherapy implant using iodine-125 seeds to deliver a prescribed dose of 145 Gy to the index lesion. RESULTS: The mean focal planning target volume (F-PTV) as a percentage of the prostate volume was 24.5%. The percentage of the focal gross tumour volume (F-GTV) receiving 100% of the prescription dose was 100% for 12 patients and >/=98% for 18 patients. The median follow-up for toxicity and biochemical control outcomes was 23.1 [interquartile range (IQR) 19.1-31.3] and 24.2 (IQR 17.9-30.0) months, respectively. Grade 2 urinary and erectile toxicities were reported by 29.2% and 45.8% of patients, respectively, with resolution of urinary symptoms to baseline by last follow-up. There were no grade >/=3 urinary or erectile toxicities or grade >/=2 rectal toxicity. All 21 patients who underwent a repeat mp-MRI and TP biopsy at 12-24 months post-treatment were negative for clinically significant disease and 25 (96.2%) patients were free from biochemical failure (FFBF). CONCLUSIONS: Focal LDR brachytherapy is associated with a favourable toxicity profile and a high rate of control of significant PCa at 12-18 months post-treatment. We have commenced the LIBERATE prospective registry in focal LDR brachytherapy based on the highly encouraging outcomes of this initial experience.
Department(s): Surgical Oncology
PubMed ID: 34733655
Publisher's Version: https://doi.org/10.21037/tau-21-508
Open Access at Publisher's Site: https://doi.org/10.21037/tau-21-508
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-05-23 08:13:49

Last Modified: 2025-05-23 08:15:07