Detection of prostate specific transcripts in the peripheral blood during brachytherapy predicts postoperative PSA kinetics.

BACKGROUND: We evaluated whether detection of prostate-specific antigen (PSA) and human kallikrein 2 (hK2) transcripts in the peripheral blood during brachytherapy could predict biochemical outcome. METHODS: Eighty-one patients who underwent (125)Iodine-based brachytherapy for localized prostate cancer (Gleason score <8, PSA <20 ng/ml, stage

[Brachytherapy combined with external beam radiation in localized prostate cancer].

BACKGROUND & RATIONALE: A combination of brachytherapy with external beam radiotherapy is one treatment option for localized moderately to poorly differentiated prostate cancer. This article presents initial Israeli experience with this treatment option. METHODS: In the last 6 years, 56 men were treated with a combination of internal brachytherapy, external beam radiation and 6 months adjuvant hormonotherapy. All were prospectively followed while using validated questionnaires to assess urinary morbidity and sexual function. RESULTS: Treatment was well tolerated by all. None had grade 2-3 rectal morbidity. Mild to moderate urinary morbidity was seen in most, not different than seen in radiation therapy when given as monotherapy. Sexual function was only mildly affected. Biochemical NED (PSA based) rates albeit for a rather short follow-up period, were similar to those seen when utilizing other radical treatment options. CONCLUSIONS: Combining I125-brachytherapy with external beam radiation together with a short course of hormonotherapy results in acceptable morbidity and good biochemical outcome. This option should be offered to selected patients with higher grade localized prostate cancer, when other options are less optimal.

Prospective comparison of PSA kinetics following two different prostate cancer brachytherapy planning methods: preoperative and real-time intraoperative dosimetry planning.

OBJECTIVES: Preoperative planning (PP) and intraoperative planning (IoP) are established (125)I-brachytherapy techniques for the treatment of localized prostate cancer. We prospectively compared the effects of each method on reducing PSA levels. MATERIALS AND METHODS: One hundred eighty patients treated with brachytherapy as monotherapy without neoadjuvant androgen deprivation therapy or external beam radiation using PP (75) or IoP (105) methodologies and with ≥ 5 years of follow-up were included in the study. CT-based dosimetry was calculated 1 month postoperatively. PSA was obtained every 3 months for the first year and semiannually thereafter. Available PSA and dosimetric data from both groups were analyzed and compared. RESULTS: At 5 years after brachytherapy, the probability of having a nadir PSA value < 0.5 ng/ml was 90% in the IoP group compared with 60% in the PP group (P < 0.0001). The rate of PSA decline was 3-fold faster in the IoP group than in the PP group. Dosimetry results highly favored the IoP method: mean V(100) (%) and D(90) (Gy) were 95 and 180 vs. 60 and 81 (P < 0.001), respectively. CONCLUSIONS: Our initial finding of highly superior postimplant CT dosimetry calculations of the IoP method are now substantiated by the biochemical favorable results (PSA kinetics) of this method.

Preimplant predictive factors of urinary retention after iodine 125 prostate brachytherapy.

OBJECTIVES: To assess the rate and predictive factors of urinary retention after iodine 125 brachytherapy for localized prostate cancer. METHODS: Between 1998 and 2006, 655 patients with localized prostate cancer (T1-2, Gleason score 7 or less) were treated with brachytherapy at our institution. 42% received neoadjuvant hormonotherapy for prostate downsizing or when brachytherapy was combined with external beam radiation (10%). They underwent real-time interactive implantation (79%) or a preplanned technique (21%). Clinical, treatment-related and dosimetric factors were evaluated for catheterization requirement because of urinary retention. All patients received alpha1-blockers before and throughout at least 30 days posttreatment. RESULTS: Twenty-one (3.2%) patients required catheterization because of urinary retention. Median time to retention onset was 1 day postimplantation. Univariate and multivariate analyses demonstrated that preimplant ultrasound (US)-based prostate volume and preimplant international prostate symptom scores (IPSS) were significant independent predictive factors for urinary retention (odds ratio [OR] = 6.8 and 3.1, 95% CI = 2.3-11.4 and 0.2-5.9, P = 0.02 and P = 0.03, respectively). Eight catheterized patients were successfully relieved from their catheter by nonsurgical means and 13 underwent minimal (channeling) transurethral resection of the prostate (TUR-P) not earlier than 6 months postimplant. Mean volume of resected prostate tissue was 9.9 mL (range 4.5-15). The perioperative and postoperative courses were uneventful. There was no TUR-P-related incontinence. CONCLUSIONS: Catheterization for acute urinary retention after brachytherapy is an uncommon event. Our data suggest that preimplant US-based prostate volume and IPSS are the strongest predictors for catheterization. Catheterized patients who are refractory to medical therapy can safely undergo a minimal TUR-P.

Iodine-125 brachytherapy for localized prostate cancer and urinary morbidity: a prospective comparison of two seed implant methods-preplanning and intraoperative planning.

OBJECTIVES: To compare morbidity between two currently used iodine-125 seed implantation techniques for the treatment of localized prostate cancer. METHODS: Iodine-125 brachytherapy was used in 300 consecutive men with localized prostate cancer. Two seed implant techniques were used: preplanning, using preloaded needles, and intraoperative planning, using a Mick applicator. A comparison was made between the groups for urinary morbidity. The International Prostate Symptom Score was assessed prospectively among all patients. Computed tomography-based implant quality parameters were correlated with lower urinary system morbidity. RESULTS: The median follow-up was 30 months. In both treatment groups, the International Prostate Symptom Score increased significantly for about 9 to 12 months and returned to baseline thereafter. The International Prostate Symptom Scores reached a higher level and remained at a higher level for a longer period in the intraoperative group. Although the differences were statistically significant, they were of mild clinical importance. Overall, the incidence of acute retention and the need for surgery was very low in both groups (2% and 1%, respectively). No differences were noted between the two groups. Significantly better computed tomography-based implant dosimetry parameters were noted with the intraoperative method. A positive correlation (P < 0.001) was found between the dosimetry parameters and symptom severity. CONCLUSIONS: This prospective study reports the first large-scale comparison of urologic outcomes after two different seed implant techniques. Both were associated with very low urinary retention rates or other grade 3 or greater urologic morbidity. Almost all men had worse urinary symptoms for the first 6 to 9 months, regardless of the seed implant technique used. Patients treated with the intraoperative method demonstrated toxicity for a longer duration. Because of the much better gland isodose coverage and greater doses delivered in the intraoperative seed implantation, we favor this method.