Long term outcome of high dose rate (HDR) brachytherapy for intermediate and high risk prostate cancer with a median follow up of 10 years

To evaluate the long term outcome of high dose rate brachytherapy (HDR) for patients with intermediate and high risk prostate cancer SUBJECTS, PATIENTS AND METHODS: We retrospectively analysed the prospective longitudinal cohort data base of a single surgeon series of 507 consecutive patients treated with external beam radiotherapy and a high dose rate prostate brachytherapy boost (HDR) between August 2000 and December 2009. The risk factors are based on the D'Amico classification. We measured the incidence of biochemical freedom of recurrent prostate cancer (bNED) based on the Phoenix definition of failure (nadir + 2). We also reviewed the incidence of urethral stricture in this cohort.

With a minimum follow up of 6 years and a median follow up of 10.3 years, the bNED for intermediate and high risk disease is 93.3 and 74.2% at 5 years respectively and 86.9% and 56.1% at 10 years. Patients with only 1 intermediate risk factor had a 10 year bNED of 94%, whereas patients with all 3 high risk factors had a 10 year bNED of 39.5%. The overall urethral stricture rate was 13.6%. Prior to 2005 the urethral stricture rate was 28.9% and after January 2005 was 4.2%. For the 271 men with a minimum follow up of 10 years the actual 10 year prostate cancer specific survival is 90.8% and actual overall survival is 86.7%.

High dose rate prostatic brachytherapy remains an appropriate treatment option for patients with intermediate or high risk prostate cancer features, who are considered not suitable for, or wish to avoid a radical prostatectomy. From December 2004, prevention strategies decreased the risk of post brachytherapy urethral strictures. This article is protected by copyright. All rights reserved.

BJU international. 2016 Sep 15 [Epub ahead of print]

J W Yaxley, K Lah, J P Yaxley, R A Gardiner, H Samaratunga, J MacKean

Wesley Medical Centre Brisbane Australia. ., Royal Brisbane and Women's Hospital Brisbane Australia., Townsville Hospital Australia., Aquesta Pathology Brisbane Australia., Wesley Medical Centre Brisbane Australia.