Iodine-125 thin seeds decrease prostate swelling during transperineal interstitial permanent prostate brachytherapy.

INTRODUCTION: Prostate swelling following seed implantation is a well-recognised phenomenon. The purpose of this intervention was to assess whether using thinner seeds reduces post-implant swelling with permanent prostate brachytherapy. METHODS: Eighteen consecutive patients eligible for prostate seed brachytherapy underwent seed implantation using iodine-125 (I-125) thin seeds. Operative time, dosimetry, prostate swelling and toxicity were assessed and compared with standard I-125 stranded seed controls, sourced from the department's brachytherapy database. RESULTS: A learning curve was noted with the thin seeds in terms of greater bending and deviation of needles from their intended path. This translated into significantly longer total operative time (88 vs 103 minutes; P = 0.009, 95% confidence interval (CI) 4.1-24.3) and time per needle insertion (2.6 vs 3.7 minutes; P < 0.001, 95% CI 0.5-1.3) for the thin seeds. Day 30 prostate volumes were significantly smaller in the thin seed group compared with standard seeds (40.9 cc vs 46.8 cc; P = 0.001, 95% CI 1.5-5.6). The ratio of preoperative transrectal ultrasound to day 30 post-implant CT volume was also smaller in the thin seed group (1.2 ± 0.1 for standard seeds vs 1.1 ± 0.1 for thin seeds). Post-implant dosimetric parameters were comparable for both groups. No significant differences were seen in acute urinary morbidity or quality of life between the two groups. CONCLUSIONS: I-125 thin seeds are associated with an initial learning curve, with longer operative time, even for experienced brachytherapists. The significant reduction in day 30 prostate volumes with the thin seeds has useful implications in terms of optimising dose coverage to the prostate in the early period post-implantation, as well as improving the accuracy of post-implant dosimetric assessments.

Prospective study of exercise intervention in prostate cancer patients on androgen deprivation therapy.

INTRODUCTION: Androgen deprivation therapy (ADT) is an important component of modern prostate cancer treatment. Survival benefits from neo-adjuvant and adjuvant hormones may take years to manifest, and balancing this with potential morbidity of therapy can be challenging. This study aimed to assess whether education and short-term combined aerobic and resistance exercises could help to ameliorate the adverse side effects of ADT. METHODS: Eight hundred fifty-nine patients with relapsed or metastatic prostate cancer on leuprorelin acetate were allocated to three interventional streams based on patient preference and medical fitness: supervised group (Face-to-Face) exercise sessions, home-based (At Home) exercise or a support programme for those incapable of exercising (Support). Patients enrolled onto Face to Face underwent measurement of body composition and cardiorespiratory fitness variables at baseline and programme completion. Patients in the exercise streams were surveyed to determine the programme's impact on physical fitness and well-being. RESULTS: Statistically significant improvements (p < 0.001) were seen in all measured cardiorespiratory fitness and strength variables. Programme attrition rates were low (75/859; 8.7%), the primary reason for withdrawal being discontinuation of hormones (70%). Programme satisfaction was high, with 98% of surveyed patients reporting a positive impact on fitness and 97% planning to continue exercising after programme completion. At 6 months, improved physical and emotional well-being was reported by 93 and 79% of patients, respectively. CONCLUSIONS: A short-term structured exercise intervention results in high compliance and significant improvements in muscle strength and cardiorespiratory fitness in prostate cancer patients on ADT.

First report of transperineal polyethylene glycol hydrogel spacer use to curtail rectal radiation dose after permanent iodine-125 prostate brachytherapy.

PURPOSE: To demonstrate the feasibility of transperineal polyethylene glycol (PEG) hydrogel insertion into anterior perirectal fat for reducing rectal radiation dose in patients with suboptimal rectal dosimetry after permanent iodine-125 prostate brachytherapy. METHODS AND MATERIALS: Five patients with suboptimal rectal dosimetry after iodine-125 seed brachytherapy implant underwent a single transperineal injection of PEG hydrogel into the anterior perirectal fat under general anesthetic using transrectal ultrasound guidance. Prostate-rectum separation and rectal radiation dose before and after PEG hydrogel spacer insertion were measured. Toxicity because of spacer insertion was assessed at Days 0-1 and 4-6 weeks using National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. RESULTS: All patients experienced a clinically significant reduction in the volume of rectum receiving greater than or equal to the prescription dose (RV100) on the postspacer postimplant dosimetry, compared with the prespacer postimplant dosimetry. Mean prostate-rectum separation that was achieved with the insertion of the spacer was 15.1 mm (±3.4). The mean difference in separation from before to after spacer insertion was 12.5 mm (±4.5). This was associated with a reduction in mean RV100 from 3.04 (±1.2) to 0.06 (±0.1) cc. Toxicities were limited to Grade 1 (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0) perineal pain and rectal discomfort (3/5 patients). There were no Grade 2 or greater toxicities reported after insertion of the spacer. CONCLUSIONS: PEG hydrogel is safe and effective at reducing rectal radiation dose in select patients with suboptimal rectal dosimetry after prostate seed brachytherapy.