Brachytherapy viable cancer treatment for small prostates
MedWire News: The results of the largest review to date of brachytherapy for men with prostate cancer with glands measuring under 20 cm3 indicate that the treatment is viable and offers acceptable rates of urinary and rectal morbidity.
Men with prostates this small are not usually recommended for brachytherapy treatment on account of the potential toxicity resulting from high urethral doses and inadequate dosimetry, explains the research team in the International Journal of Radiation Oncology Biology Physics.
Gregory Merrick, from Wheeling Hospital in West Virginia, USA, and colleagues report: “Our results show that high-quality postimplant dosimetry is readily achievable and that biochemical outcomes are comparable to those in patients with larger prostate glands.”
The team investigated dosimetry, treatment-related morbidity, and biochemical outcomes including cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS), among 104 men with prostates under 20 cm3 who were treated with brachytherapy.
Patients were followed up for a median of 5 years during which time they were physically examined and had prostate-specific antigen measurements taken at 3–6 month intervals. The mean and maximum doses to the urethra were 119.6% and 133.8% of prescription, and the mean area of the rectum receiving 50 Gy and 100 Gy was 2.20 cm3 and 0.06 cm3, respectively.
After 9 years, CSS, bPFS, and OS rates were 100%, 92.7%, and 77.8%, respectively. In the 31 patients who did not receive androgen deprivation therapy prior to brachytherapy, CSS, bPFS, and OS rates were 100%, 100%, and 72.5%, respectively.
No patient required a catheter beyond 4 days after implant, with 92% of patients having it removed on the day of the implant. Furthermore, the median time until the mean International Prostate Symptom Score (6.5 – mildly symptomatic) reverted to baseline was 4 months, and all but 3% of patients reverted to baseline.
Intermittent rectal bleeding was experienced by seven patients, which was resolved within a year of onset, and no Grade 3 or 4 Radiation Oncology Group rectal complications were reported, observe the researchers.
“This study suggests that patients with prostate gland volumes under 20 cm3 should be offered brachytherapy as a viable treatment option for prostate cancer,” conclude Merrick and team.
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By Sarah Guy