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Taniguchi T, Kawase M, Nakane K, Nakano M, Iinuma K, Kato D, Takai M, Tobisawa Y, Mori T, Takano H, Kumano T, Matsuo M, Ito T, Koie T. Prognostic Factors for Resolution Delay of Lower Urinary Tract Symptoms in Patients with Prostate Cancer after Low-Dose-Rate Brachytherapy. Cancers (Basel) 2023; 15:4048. [PMID: 37627078 PMCID: PMC10452417 DOI: 10.3390/cancers15164048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Urinary storage symptoms after low-dose-rate brachytherapy (LDR-BT) with iodine-125 have been noted to be less likely to improve to baseline compared to voiding symptoms. This study aimed to evaluate the chronological changes in the overactive bladder symptom score (OABSS) and the time-to-resolution of OABSS in patients undergoing LDR-BT. Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were enrolled. The OABSS was evaluated before and after LDR-BT. Patients were divided into the OABSS resolution and resolution delay groups, and the association between OABSS resolution delay and clinicopathological covariates was evaluated. In total, 237 patients were enrolled in this study, with a median follow-up of 88.3 months. The OABSS in both groups worsened at 3 months following operation and gradually recovered at 9 months; however, the OABSS in the resolution delay group tended to worsen again after that. In the multivariate analysis, preoperative OABSS and the change from baseline to maximal OABSS were associated with OABSS resolution. To our knowledge, this is the first study to evaluate the delayed resolution of OABSS after LDR-BT in patients with prostate cancer. A low baseline OABSS and significant changes in the OABSS from baseline were independent predictors of delayed OABSS resolution.
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Affiliation(s)
- Tomoki Taniguchi
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu 5038502, Japan;
| | - Makoto Kawase
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Keita Nakane
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1 Noisiki, Gifu 5008717, Japan;
| | - Koji Iinuma
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Daiki Kato
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Manabu Takai
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Yuki Tobisawa
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Takayuki Mori
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Hirota Takano
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Tomoyasu Kumano
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Masayuki Matsuo
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan;
| | - Takuya Koie
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu 5038502, Japan;
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Keller A, Abdelhakiem M, Mulherkar R, Ghanta S, Benoit R, Smith RP, Beriwal S. Effect of short-term corticosteroid usage on acute urinary toxicity following Cs-131 prostate brachytherapy. Brachytherapy 2022; 21:468-474. [PMID: 35514004 DOI: 10.1016/j.brachy.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/27/2022] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate short-term patient reported urinary quality of life scores in patients with prostate cancer treated at our institution with and without perioperative prednisone following Cesium-131 (131Cs) prostate LDR brachytherapy. METHODS AND MATERIALS We started routinely using a perioperative 7-day course of prednisone at a dose of 5 mg per day, beginning 1 day prior to 131Cs prostate LDR brachytherapy from 2013 with goal of improving acute urinary symptomatology. One hundred consecutive patients treated with prednisone were selected, with comparison to 100 consecutive patients who were not treated with prednisone. We analyzed for differences in mean change with standard deviation (SD) in EPIC and AUA scores at 0.5-1 month and 3 months with or without prednisone by Mann-Whitney U Test. Binary logistic regression was performed to assess for impact of prednisone on postoperative urinary catheter use. RESULTS Pretreatment EPIC and AUA scores were available in 197 patients. Less reduction in EPIC US score was noted at 0.5-1.0 month in the group who received prednisone with mean change of -22.9 (SD 15.4) when compared to the group who did not receive prednisone with mean change of -31.7 (SD 19.3), p < 0.01, with significance lost at 3 months. There was no significant difference in acute urinary retention requiring postoperative urinary catheter placement with perioperative prednisone (OR 1.13, p = 0.71). CONCLUSIONS A short course of perioperative low-dose prednisone was associated with less severe worsening in urinary symptoms by the EPIC questionnaire at the 0.5-1.0-month timepoint suggesting some improvement in acute urinary quality of life, although differences did not remain statistically significant at 3 months.
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Affiliation(s)
- Andrew Keller
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Mohamed Abdelhakiem
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Ria Mulherkar
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | | | - Ronald Benoit
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ryan P Smith
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA.
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Onishi K, Tanaka N, Miyake M, Nakai Y, Anai S, Torimoto K, Yamaki K, Asakawa I, Hasegawa M, Fujii T, Konishi N, Fujimoto K. Changes in lower urinary tract symptoms after iodine-125 brachytherapy for prostate cancer. Clin Transl Radiat Oncol 2018; 14:51-58. [PMID: 30547097 PMCID: PMC6282112 DOI: 10.1016/j.ctro.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
Patients who received BT experienced acute urinary morbidity 3 months after BT of the prostate. Acute urinary symptoms gradually improved with time and returned to BL at 36 months. Storage symptoms take longer to return to BL compared with voiding symptoms.
Purpose To investigate chronological changes in lower urinary tract symptoms (LUTS) in patients who received iodine-125 brachytherapy (BT) for prostate cancer. Methods We enrolled 706 patients who received BT. Of these, 265 (38%) received BT combined with external beam radiation therapy (EBRT). An International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL) score, and overactive bladder symptom score (OABSS) were recorded before BT (baseline, BL), and 1, 3, 6, 12, 24, 36, 48, and 60 months after BT. The sum of frequency (2), urgency (4) and nocturia (7) of the IPSS questionnaire was defined as the storage symptoms score, whereas the sum of emptying (1), intermittency (3), weak stream (5), and hesitancy (6) was defined as the voiding symptom score. Results Total IPSS significantly increased at 3 months following BT compared with BL (mean score: 17.1 vs. 7.99, P < 0.001) and returned to BL by 36 months. The storage symptom score did not return to BL 36 months after BT. Total OABSS significantly increased 3 months after BT compared with BL (mean score: 6.52 vs. 3.45, P < 0.001), and returned to BL 48 months after BT. The IPSS-QOL score was the highest score (mean score: 2.46 vs. 3.9, P < 0.001) 3 months after BT and returned to BL 48 months after BT, however the IPSS-QOL score was lower than BL (mean score: 2.01 vs 2.46, P < 0.001) at 60 months. The risk factors for LUTS within 1 year after BT were BL IPSS (P < 0.001) and PV (P < 0.001). Patients who received combined EBRT experienced transient storage symptoms 24 and 36 months after BT, whereas those who received BT alone did not. However, the storage symptom score of the patients who received combined EBRT was improving 48 months after BT and eventually showed no significant difference compared with those treated with BT alone. Conclusion Three months after BT, LUTS, including storage symptoms, deteriorated the most but improved with time. The urinary symptom in patients who received combined EBRT can potentially flare again in 24 and 36 months after BT. Knowledge of changes in LUTS associated with BT may influence treatment recommendations and enable patients to make better-informed decisions.
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Key Words
- BL, baseline
- BT, brachytherapy
- Brachytherapy
- EBRT, external beam radiation therapy
- GS, Gleason score
- IMRT, intensity modulated radiation therapy
- IQR, interquartile
- LUTS, lower urinary tract symptoms
- Lower urinary tract symptom
- NADT, neoadjuvant androgen deprivation therapy
- PV, prostate volume
- Prostate cancer
- QOL, quality of life
- Quality of life
- Urinary symptom flare
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Affiliation(s)
- Kenta Onishi
- Department of Urology, Nara Medical University, Japan
| | | | - Makito Miyake
- Department of Urology, Nara Medical University, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Japan
| | | | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Japan
| | | | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Japan
| | - Noboru Konishi
- Department of Diagnostic Pathology, Kouseikai Takai Hospital, Japan
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Stish BJ, Davis BJ, Mynderse LA, McLaren RH, Deufel CL, Choo R. Low dose rate prostate brachytherapy. Transl Androl Urol 2018; 7:341-356. [PMID: 30050795 PMCID: PMC6043740 DOI: 10.21037/tau.2017.12.15] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Low dose rate (LDR) prostate brachytherapy is an evidence based radiation technique with excellent oncologic outcomes. By utilizing direct image guidance for radioactive source placement, LDR brachytherapy provides superior radiation dose escalation and conformality compared to external beam radiation therapy (EBRT). With this level of precision, late grade 3 or 4 genitourinary or gastrointestinal toxicity rates are typically between 1% and 4%. Furthermore, when performed as a same day surgical procedure, this technique provides a cost effective and convenient strategy. A large body of literature with robust follow-up has led multiple expert consensus groups to endorse the use of LDR brachytherapy as an appropriate management option for all risk groups of non-metastatic prostate cancer. LDR brachytherapy is often effective when delivered as a monotherapy, although for some patients with intermediate or high-risk disease, optimal outcome are achieved in combination with supplemental EBRT and/or androgen deprivation therapy (ADT). In addition to reviewing technical aspects and reported clinical outcomes of LDR prostate brachytherapy, this article will focus on the considerations related to appropriate patient selection and other aspects of its use in the treatment of prostate cancer.
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Affiliation(s)
- Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Characterizing Clinically Meaningful Changes in Lower Urinary Tract Symptoms Using the American Urological Association Symptom Index. Urology 2018; 115:139-143. [PMID: 29410322 DOI: 10.1016/j.urology.2018.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/01/2017] [Accepted: 01/20/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To correlate patients' perception of changes in their lower urinary tract symptoms with changes in their American Urological Association Symptom Index (AUA-SI) scores with the goal of improving the ability of patients and clinicians to assess the clinical meaningfulness of changes in the AUA-SI score. MATERIALS AND METHODS Men were asked to complete an AUA-SI survey and answer a symmetrical response framework question to evaluate their global perception of change in lower urinary tract symptoms at each interval, namely, "Are your urinary symptoms much better, slightly better, the same, slightly worse, or much worse compared to your prior visit?" Median changes and interquartile ranges (IQRs) in the AUA-SI scores were compared with the global evaluation response for the entire cohort. Additionally, outcomes were stratified by baseline AUA-SI severity classification (mild, moderate, or severe). RESULTS The median changes and IQRs in AUA-SI scores of patients rating themselves as much better, slightly better, the same, slightly worse, and much worse compared with their symptoms at the time of their last AUA-SI were -2 (IQR -6 to 0), -1 (IQR -5 to 1), 0 (IQR -2 to 2), 5 (IQR 0-9), and 11 (IQR 5-18), respectively. There was a significant difference in AUA-SI score change between each rating category (P <.001). CONCLUSION These results demonstrate that the patients require only a small decrease in their AUA-SI scores to report they are slightly better or much better, whereas a larger increase in their AUA-SI scores is required for patients to report their symptoms are slightly worse or much worse.
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Blanchard P, Pugh TJ, Swanson DA, Mahmood U, Chen HC, Wang X, Graber WJ, Kudchadker RJ, Bruno T, Feeley T, Frank SJ. Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study. Brachytherapy 2017; 17:265-276. [PMID: 29269207 DOI: 10.1016/j.brachy.2017.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. METHODS AND MATERIALS Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. RESULTS From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. CONCLUSIONS The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.
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Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado School of Medicine, Houston, TX
| | - David A Swanson
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Usama Mahmood
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hsiang-Chun Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William J Graber
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa Bruno
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Steven J Frank
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Agrawal S, Lacy JM, Bagga H, Angermeier KW, Ciezki J, Tendulkar RD, Reddy CA, Wood HM. Secondary Urethral Malignancies Following Prostate Brachytherapy. Urology 2017; 110:172-176. [PMID: 28882777 DOI: 10.1016/j.urology.2017.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand urethral secondary malignancies among patients treated with brachytherapy (BRT) for primary prostate cancer. PATIENTS AND METHODS Institutional retrospective review identified 13 patients evaluated from 2003 to 2014 with urethral cancer and history of BRT monotherapy for prostate cancer. All patients were biochemically free of their primary disease and radiation-associated secondary malignancies (RASMs) were confirmed pathologically to be histologically distinct from primary tumor. BRT characteristics, patient age, presentation, staging workup, and clinical course were evaluated. RESULTS The mean time from BRT to presenting symptoms of hematuria, urinary retention, and/or renal failure was 71 months. Symptom onset to RASM diagnosis interval was 24 months. Mean time from BRT to RASM diagnosis was 95 months. Eighty-five percent of patients had an undetectable prostate-specific antigen level (<0.2 ng/mL) at last follow-up. Types of RASM included sarcomatoid carcinoma (6), small cell carcinoma (2), urothelial carcinoma with squamous differentiation (2), squamous cell carcinoma (1), rhabdomyosarcoma (1), and urothelial carcinoma (1). A majority of patients were diagnosed with advanced disease with either distant metastases (54%) or local progression (23%). Ten patients died during this study period with median time to death after RASM diagnosis of 6 months. CONCLUSION RASMs localized to the posterior urethra displayed advanced disease and high mortality rates. Refractory lower urinary tract symptoms, hematuria, and history of prostate BRT should raise suspicion for urethral RASMs. Further studies are warranted to determine patient and disease characteristics that correlate with disease-specific mortality of secondary urethral malignancies.
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Affiliation(s)
- Shree Agrawal
- Case Western Reserve University School of Medicine, Cleveland, OH.
| | - John M Lacy
- University of Tennessee Graduate School of Medicine, Knoxville, TN
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Jellison FC. Evaluation and Treatment of Overactive Bladder after History of Cancer Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brachytherapy in the therapy of prostate cancer - an interesting choice. Contemp Oncol (Pozn) 2013; 17:407-12. [PMID: 24596528 PMCID: PMC3934024 DOI: 10.5114/wo.2013.38557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 10/10/2013] [Accepted: 10/18/2013] [Indexed: 12/15/2022] Open
Abstract
Brachytherapy is a curative alternative to radical prostatectomy or external beam radiation [i.e. 3D conformal external beam radiation therapy (CRT), intensity-modulated radiation therapy (IMRT)] with comparable long-term survival and biochemical control and the most favorable toxicity. HDR brachytherapy (HDR-BT) in treatment of prostate cancer is most frequently used together with external beam radiation therapy (EBRT) as a boost (increasing the treatment dose precisely to the tumor). In the early stages of the disease (low, sometimes intermediate risk group), HDR-BT is more often used as monotherapy. There are no significant differences in treatment results (overall survival rate – OS, local recurrence rate – LC) between radical prostatectomy, EBRT and HDR-BT. Low-dose-rate brachytherapy (LDR-BT) is a radiation method that has been known for several years in treatment of localized prostate cancer. The LDR-BT is applied as a monotherapy and also used along with EBRT as a boost. It is used as a sole radical treatment modality, but not as a palliative treatment. The use of brachytherapy as monotherapy in treatment of prostate cancer enables many patients to keep their sexual functions in order and causes a lower rate of urinary incontinence. Due to progress in medical and technical knowledge in brachytherapy (“real-time” computer planning systems, new radioisotopes and remote afterloading systems), it has been possible to make treatment time significantly shorter in comparison with other methods. This also enables better protection of healthy organs in the pelvis. The aim of this publication is to describe both brachytherapy methods.
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