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Keywords:

  • brachytherapy;
  • erectile dysfunction;
  • quality of life;
  • rectum;
  • urination disorders

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

  • • 
    Prostate BXT is an established treatment option for low and intermediate risk localized prostate cancer. Long-term studies have confirmed similar oncological outcomes for low risk disease compared with radical prostatectomy and external beam radiotherapy.
  • • 
    This study reports long-term toxicity for a large cohort of patients who had been followed-up after LDR BXT for up to 10 years, with a minimum follow-up of 5 years.
  • • 
    Long-term toxicity results are very encouraging and provide useful date to help clinicians and patients make informed treatment choices.

OBJECTIVE

  • • 
    To report on the long-term toxicity outcome for patients with prostate cancer treated by low-dose rate (LDR) brachytherapy (BXT).

PATIENTS AND METHODS

  • • 
    The study population comprised a cohort of men treated in our centre between March 1999 and April 2004 with LDR BXT for prostate cancer who had at least 5 years of follow-up post-implant.
  • • 
    Patients who had died or experienced biochemical failure were excluded.
  • • 
    We contacted eligible patients and asked them to complete a questionnaire to assess current urinary, erectile and bowel function.
  • • 
    Urinary and erectile function was compared pre- and post-treatment and outcomes were assessed by treatment modality.

RESULTS

  • • 
    Of the 226 LDR BXT-treated patients with >5 years of follow-up, 174 (77.0%) responded to the questionnaire.
  • • 
    The mean International Prostate Symptom Score (IPSS) increased from 6.70 pre-BXT to 7.91 at follow-up (P= 0.003). Of the patients with mild symptoms pre-BXT (IPSS, 0–7), 64.2% retained mild symptoms at follow-up, 31.2% developed moderate symptoms (IPSS, 8–9) and 4.6% reported severe symptoms (IPSS, 20–35).
  • • 
    A good or acceptable quality of life (QoL) secondary to urinary symptoms (IPSS QoL, 0–4) was reported by 98.0% of respondents.
  • • 
    Of those patients potent (International Index of Erectile Function-5 ≥11) pre-BXT, 62.9% remained potent at follow-up. There were no differences in the proportion of patients who were potent when analyzed by the number of years post-implant.
  • • 
    At follow-up, 51.7% and 45.4% of patients, respectively, had normal or mild bowel symptoms as indicated by the European Organisation for the Research and Treatment of Cancer questionnaire (QLQ-C30/PR25 scores, 4–8). Moderate bowel symptoms (QLQ-C30/PR25 scores, 9–12) were reported by 2.9% of respondents; none reported severe symptoms.

CONCLUSION

  • • 
    The present study shows low morbidity after LDR BXT over the long-term for a large cohort of patients.