[Focal dose escalation in the treatment of prostate cancer : Long-term results of HDR brachytherapy].

We prospectively examined the effect and the safety of intensity-modulated HDR brachytherapy (IMBT) with focal dose escalation.

A total of 139 patients undergoing primary therapy for prostate cancer and 11 patients with recurrence were included. Data analysis focused on the following factors: date of primary diagnosis, Gleason score, initial prostate-specific antigen (PSA) value, PSA nadir, volume of the prostate in the transrectal ultrasound, biopsy of the prostate gland, androgen deprivation, chemotherapy, uroflowmetry, pre- and postoperative post-void residual urine (PVR), number of the needles in the prostate lobes and analysis of follow-up data.

In the primary therapy group, 87.6 % of the patients had a PSA of 0-4 ng/ml at the time of follow-up, while in the recurrence group 81.8 % of patients were within this range. Overall, 55.8 % of patients in the primary group had a PSA nadir under 0.1 ng/ml, 37.2 % under 1 ng/ml, 5.8 % under 5 ng/ml and 1.2 % (1 patient) over 5 ng/ml. In the recurrence group, 100 % had a PSA nadir under 0.1 ng/dl. Fifty patients of the primary group reported grade 1 toxicity (Common Toxicity Criteria): 29 localized to the bladder and 21 to the rectum. Seventeen patients had grade 2 toxicity of the bladder and 1 patient had grade 3 toxicity of the bladder. Finally there was one grade 4 toxicity due to perforation of the sigmoid colon. In the recurrence group, 3 patients with grade 1 toxicity were observed (2 bladder and 1 bowl). Also 3 patients had grade 2 toxicity of the bladder, 1 patient had a grade 3 bladder toxicity and 1 patient had grade 4 toxicity due to bowl fistula. There were no grade 5 toxicities.

The modifications of the "Kiel method" with focal dose escalation was proven as effective in locally advanced prostate carcinoma and in local recurrences of the disease with low level toxicity.

Der Urologe. Ausg. A. 2016 Jul 04 [Epub ahead of print]

J Cordes, J Broschk, M Sommerauer, D Jocham, A S Merseburger, C Melchert, G Kovács

Klinik und Poliklinik für Urologie, Campus Lübeck, Universitätsklinikum Schleswig- Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. ., Klinik und Poliklinik für Urologie, Campus Lübeck, Universitätsklinikum Schleswig- Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland., Klinik für Urologie und Kinderurologie, DIAKO Ev. Diakonie-Krankenhaus gemeinnützige GmbH, Bremen, Deutschland., Klinik und Poliklinik für Urologie, Campus Lübeck, Universitätsklinikum Schleswig- Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland., Klinik und Poliklinik für Urologie, Campus Lübeck, Universitätsklinikum Schleswig- Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland., Bereich Interdisziplinäre Brachytherapie, Universität zu Lübeck/UKSH Campus Lübeck, Lübeck, Deutschland., Bereich Interdisziplinäre Brachytherapie, Universität zu Lübeck/UKSH Campus Lübeck, Lübeck, Deutschland.