LDR brachytherapy for the treatment of localised prostate cancer in men with a high risk of disease relapse

To report clinical outcomes of Iodine-125 Low-Dose-Rate Prostate Brachytherapy (LDR-PB) as monotherapy or in combination with androgen deprivation therapy (ADT) and/or external beam radiotherapy (EBRT) in high-risk localised prostate cancer (PCa).

Analysis of clinical outcomes from a prospective cohort of patients treated with LDR-PB alone or combination treatment in a single institution. Men with a high risk of disease relapse were identified by the National Institute for Healthcare Excellence (NICE) criteria or by the National Comprehensive Cancer Network (NCCN) criteria. Relapse-free survival (RFS), overall survival (OS), prostate cancer-specific survival (PCSS) and metastases-free survival (MFS) were analysed together with patient-reported symptom scores and physician-reported adverse events.

The NICE and NCCN criteria identified 267 and 202 high-risk cases respectively. NICE-defined cases showed significantly lower pre-treatment PSA levels, Gleason scores <7 and a greater proportion of cases who received LDR-PB monotherapy. Nine years post-implant RFS was 89% and 87% in the NICE and NCCN groups respectively (log rank p=0.637) and OS 93% and 94% respectively (log rank p=0.481). All of the survival estimates were similar between LDR-PB monotherapy and combined therapies. Cox proportional hazards regression confirmed RFS was similar between the treatment types. Treatment-related toxicity was also similar between the treatment modalities.

LDR-PB is effective at controlling localised prostate cancer in patients with a high risk of disease relapse. As this study was not randomised it is not possible to define those patients who need the addition of ADT and/or EBRT. However, the NICE criteria appear suitable to define treatment options where patients could benefit from LDR-PB as monotherapy or combined treatment. This choice should be discussed with the patient taking into account comorbidities and presence of multiple high-risk factors. This article is protected by copyright. All rights reserved.

BJU international. 2018 Apr 01 [Epub ahead of print]

Robert Laing, Jennifer Uribe, Santiago Uribe-Lewis, Julian Money-Kyrle, Carla Perna, Stylianos Chintzoglou, Sara Khaksar, Stephen E M Langley

St. Luke's Cancer Centre, Guildford, United Kingdom.