Dosimetry doesn't seem to predict the control of organ-confined prostate cancer after I-125 brachytherapy. Evaluation in 150 patients.

OBJECTIVE: To evaluate the dose-response relationship (D90 >144 Gy: probable absence of biochemical failure) in patients with prostate cancer treated by iodine-125 (I-125) brachytherapy. MATERIAL AND METHODS: From May 1999 to December 2006, 150 patients were treated by I-125 brachytherapy. The median follow-up was 60 months. All patients had clinical stage T1-T2, PSA < or =10 ng/ml, Gleason Scores < or = 3+3=6, IPSS >14 ml/sec. and prostate weight <50 gr. Implantation was ultrasound-guided, using a real-time technique and loose seeds of I-125 (dose 160 Gy). After 30 days, a post-implantation assessment was performed by pelvic CT scan for a definitive evaluation of the D90. All patients were subjected to clinical evaluation, PSA dosage and compilation of IPSS and IEFF questionnaires. In the event of biochemical failure (ASTRO), a prostate biopsy was performed. A D90 >144 Gy was considered the cut-off in order to predict the absence of biochemical failure. RESULTS: Biochemical failure was observed in 9 patients: 5 with positive and 4 with negative prostate biopsies. The D90 >144 Gy cut-off was not achieved in 18 patients at the post-implantation assessment, however only 2 of them (one of whom had a positive biopsy) had biochemical failure (11.1%). On the other hand, only 2 of the 9 patients with biochemical failure had a D90 < 144 Gy while 6 patients had D90 >150 Gy, 5 with positive prostate biopsies. CONCLUSIONS: In our experience, the D90 >144 Gy cut-off does not seem to predict, in a reliable way, the control of prostate cancer following brachytherapy. Limitations of the analysis were the number of the patients, the learning curve, dosimetry processing and the relatively short follow-up.

[Prostate brachytherapy: oncological and functional results after 400 cases]. / Brachiterapia prostatica: risultati oncologici e funzionali dopo 400 casi.

INTRODUCTION: Brachytherapy (BT) with real-time technique for the treatment of low and medium risk prostate cancer (CaP) has been a well known practice for over 25 years in the USA and for over 15 years in Italy. However, it is an uncommon procedure, because of problems related to the organization and cooperation among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique.
 METHODS: Between May1999 and July 2013, 400 patients with low and medium risk CaP underwent I 125 BT using a "real-time" approach. The seeds implantation was performed using a Mick applicator in the first 190 patients and the "QuickLink" technique in the last 210 cases. Oncologic results were reported for the first 250 cases with a mean follow-up of 10 years, while functional outcomes and complications were assessed in 350 patients with a minimum follow-up of 1 year.
 RESULTS: A good quality implantation was assessed in 90% of the patients (D90>145 Gy). A biochemical failure was assessed, based on Phoenix criteria, in 12 patients (4.8%). Out of these patients, 10 underwent prostate biopsy (the other 2 patients showed a systemic disease). The biopsy showed a CaP in 6/10 patients who underwent retropubic radical prostatectomy (4 patients) and external radiotherapy (2 patients) respectively. The remaining 4/10 patients with negative biopsy were treated with total androgen blockade (3 patients) and watchful waiting (1 patient) respectively. Functional results showed an incidence of postoperative irritative disorders in 70% of the patients during the first six months and a good recovery of erectile function in 78.8% and 68.2% of the patients after one and five years from BT respectively.
 CONCLUSION: Brachytherapy is a good alternative to radical prostatectomy in the low and medium risk prostatic cancers with excellent oncologic and functional results.

Salvage low-dose-rate brachytherapy for prostate cancer local recurrence after radical prostatectomy: our first three patients.

PURPOSE OF THE STUDY: To present our initial experience with brachytherapy (BT) as a primary salvage procedure for the treatment of prostate cancer (PCa) local recurrence following radical retropubic prostatectomy (RRP). METHODS: From December 2009 to May 2010, three patients underwent salvage BT due to local recurrences of high risk PCa after extrafascial RRP without additional adjuvant therapies. Local recurrence was confirmed by prostate biopsy and the relapse was well defined by endorectal ultrasonography and magnetic resonance imaging. Metastatic screening was negative. The patients were followed-up according to the American Brachytherapy Society guidelines. RESULTS: The median dose delivered to 90% of the local relapse (D90) was 115 Gy. The three patients reached a prostate specific antigen (PSA) nadir value within the first year that remained stable at a mean follow-up of 32 months. As regards morbidity, moderate de novo urgency was reported by only one patient. CONCLUSIONS: We think that our data confirms the feasibility and safety of salvage BT as a possible alternative option to external beam radiotherapy (EBRT) for the treatment of locally recurrent PCa in selected patients when performed by experienced centers. However, larger series of patients with longer follow-ups are needed to define the oncologic role of this procedure.

[Prostate I-125 brachytherapy: critical evaluation of mid-term oncologic and functional results in 250 cases]. / Brachiterapia prostatica: valutazione critica dei risultati oncologici e funzionali a medio termine dopo 250 casi.

BACKGROUND: Even if brachytherapy (BT) in low-risk prostate cancer (CaP) is a common practice since more than 20 and 10 years in U.S.A. and Italy, respectively, it is still an uncommon procedure because of the problems related to the organization and collaboration among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique. METHODS: Between May 1999 and September 2010, 250 patients with low risk CaP underwent I125BT using a "real time" approach; the seeds implantation was performed using Mick applicator, in the first 190 patients, and the "Quick-Link" technique in the last 60 cases. Oncologic results were reported in the first 150 cases with a mean follow-up of 95 months, while functional outcomes and complications were assessed in all the patients at different time points with a mean follow-up of 65 months. RESULTS: A good quality implantation was assessed in 88% of patients (D90 >140 Gy). Overall, a biochemical failure was assessed, in accordance with Phoenix criteria, in 10 patients (6.6%). Among these patients, the prostatic biopsy showed a CaP in 6/10 patients, who underwent retropubic radical prostatectomy (4 pts) and external RT (2 pts); only one patient developed a systemic progression with secondary bone lesions and died after 122 months and 36 months from BT and RRP, respectively. The 4/10 patients with negative biopsy were treated with total androgen blockade (2 pts) and with watchful waiting (2 pts). Regarding functional results, we assessed a moderate incidence of irritative disorders (70%) during the first six months and a good recovery of erectile function after one year from surgery (78.8%). CONCLUSIONS: Brachytherapy in the low-grade risk prostatic cancer represents a good alternative to RRP with excellent functional and oncologic results

Prognostic significance of high-grade prostatic intraepithelial neoplasia (HGPIN): risk of prostatic cancer on repeat biopsies.

OBJECTIVES: To verify prognostic significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in 65 patients who underwent repeat biopsies with a mean follow-up of 36 months. METHODS: In June 2007, after a retrospective revision of the biopsy reports that were performed between January 2002 and December 2006 because of prostate specific antigen (PSA) values greater than 4 ng/mL, but no clinical or ultrasonographic parameters indicative of prostatic cancer (CaP), we selected 65 patients (group 1) (mean age 63.4 years) with initial HGPIN diagnosis and a control group of another 65 patients (group 2) (mean age 64.5 years) with initial diagnosis of benign prostatic tissue (BPT). All the patients underwent rebiopsies 3 to 12, 13 to 24, 25 to 36, and 37 to 48 months after biopsy. After each rebiopsy, 3 diagnoses were made: BPT, HGPIN, and CaP. Prognostic significance of PSA and HGPIN focality at biopsy were also assessed. RESULTS: Overall, CaP was detected in 14 of 65 (21.5%) group 1 patients and in 15 of 65 (23.0%) group 2 patients. No significant difference was reported between the 2 groups in terms of risk for CaP. Low-medium risk cancer was reported in 12 of 14 (85.7%) cases in group 1 and in 12 of 15 (80.0%) of group 2, mainly after the second rebiopsy. PSA and HGPIN focality at biopsy did not seem to predict CaP diagnosis. CONCLUSIONS: The risk for cancer after HGPIN diagnosis (21.5%) was not higher than the risk reported after BPT diagnosis (23.0%). PSA and HGPIN focality at biopsy do not enhance cancer predictivity. Patients with a HGPIN diagnosis do not seem to need any different follow-up rebiopsy strategy than patients with a BPT diagnosis.