Outcomes for prostate glands >60 cc treated with low-dose-rate brachytherapy: Beyond the Abstract

Patients with prostate cancer typically have several treatment options available to them, and brachytherapy (also known as a prostate seed implant) has become an increasingly utilized choice for men with early stage disease. 

However, the American Brachytherapy Society guidelines suggest that this modality should not be used for patients with gland size greater than 60 grams, due to concerns that the procedure may be more technically difficult and these patients may experience more side effects. At Cleveland Clinic, we have treated thousands of prostate cancer patients with brachytherapy over the past twenty years, and maintain a prospective registry to regularly examine our outcomes. 

Therefore, we felt it was an important opportunity to report our outcomes in patients with larger prostate size who opted for brachytherapy. To our knowledge, this is the largest reported series examining this issue in the literature to date. Our key findings were reassuring – patients with prostate size greater than 60 grams actually had better biochemical control (measured by prostate specific antigen, or PSA) than those with smaller prostates. The risk of late side effects was indeed higher among those with larger prostates, but at acceptable levels. The primary limitation of such an analysis was its retrospective nature and lack of patient-reported outcomes. Nonetheless, we feel that our findings suggest that larger prostate size alone should not automatically disqualify patients from brachytherapy. Multidisciplinary evaluation to counsel patients about surgical and non-surgical treatment options should continue to be encouraged. Ultimately, patients will be best served by personalized assessments of baseline function and discussion of the risks and benefits of each treatment modality.

Written by: Rahul Tendulkar, M.D., Residency Program Director, Clinical Director

Dept. of Radiation Oncology, Cleveland Clinic

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