60th Annual Conference of the German Society of Urology in Stuttgart

Prospective detection of quality of life and toxicity of HDR brachytherapy as an interstitial boost in the treatment of prostate cancer

Derakhshani P (1,2), Neubauer S (1,2), Wise C (1,3), Spira G (1,3)

(1) West German Prostate Center, Klinik am Ring, Cologne

(2) Department of Urology, Klinik am Ring, Cologne

(3) Department of Radiooncology, Klinik am Ring, Cologne

Introduction and objectives:

We report on the results, toxicity and quality of life (LQ) of combined HDR brachytherapy in localized prostate cancer of medium and high risk groups.

Methodology:

Between 04/03 and 12/06,416 patients were treated with combined HDR afterloading brachytherapy. According to AUA, 8% of patients had a low risk, 40% a medium risk and 52% a high risk. 53% of patients received hormone therapy. Validated questionnaires (IPSS, QLQ-C30, PR25 prostate module, IIEF5) were used prospectively for the registration of LQ, micturition and sexual function before and 24 months after treatment.

Results:

The median follow-up was 34 months (12-56). In medium/high risk patients, median PSA decreased from 11 ng/ml to 0.15 after 36 months. The biochemical absence of recurrence rate after 3 years was 87% according to ASTRO definition for the hormonal patients. With an IPSS of 8.9 before therapy, 3.6 and 12 months after HDR brachytherapy showed a slight deterioration (10,6,9,3,10,3). The Urinary Bother Score (UB) immediately after HDR was 30.2, but improved significantly over the following twelve months (23.6) and almost reached baseline values (19.1) after 24 months. There were no changes in intestinal function (before HDR 4.1, after HDR 5.8). The overall health before therapy was excellent (72.4) and showed only a slight deterioration over the entire follow-up period (mean 67.3). 24 months after HDR brachytherapy, the GHS reached a stable level of 69.8.

Conclusions:

Combined HDR brachytherapy for prostate cancer with a medium and high risk profile leads to excellent biochemical control and LQ with low acute and late toxicity.

 

Prospective analysis of the long-term health-relevant quality of life after definitive LDR brachytherapy of the prostate gland

Derakhshani P (1,2), Spira G (1,3), Wise C (1,3), Neubauer S (1,2)

(1) West German Prostate Center, Klinik am Ring, Cologne

(2) Department of Urology, Klinik am Ring, Cologne

(3) Department of Radiooncology, Klinik am Ring, Cologne

Introduction:

The effects on the quality of life (LQ) are important criteria before the therapy decision for patients with locally limited prostate carcinoma. The aim of the study was to record long-term changes in QoL, micturition, intestinal function and sexual function after permanent LDR brachytherapy (PB) using validated questionnaires.

Material and methods:

Between 12/00 and 06/06,939 patients were treated with a PB (125-iodine seeds). From this group, 506 consecutive patients (treated from 12/04 to 06/06) were prospectively examined with regard to quality of life, micturition and sexual function. Validated questionnaires (IPSS, QLQ-C30, PR25-Module, IIEF5) were completed before and up to 36 months after treatment.

Results:

The median follow-up of the patients was 32 months (16-41). The micturition (before PB IPSS 6.7) was clearly deteriorated in 3 and 6 months after PB (13.2/9.9), but reached the baseline level after 12 months (8.2). The micturition symptoms in the PR25 showed a significant worsening 3 and 6 months after PB, but were back to baseline after 12 months. 67.7% of the patients had normal erectile function before PB in IIEF5. erectile dysfunction 12,24 and 36 months after PB was observed in 35.3%, 31.8% and 33% of potent patients. The general state of health before PB was excellent (88.85) and remained stable after PB (89.82). There were no changes in intestinal function (before PB 3.06, after PB 5.1).

Conclusion:

The general state of health and quality of life of the patients after a PB remain excellent overall. The rate of erectile dysfunction remains stable in the long term. Our study shows that the PB only leads to a temporary deterioration of the micturition function.

 

Recurrence-free survival and dosimetric results of patients with locally limited prostate cancer after interstitial 125-iodine LDR brachytherapy

Neubauer S1,2, Derakhshani P (1,2), Wise C (1,3), Spira G (1,3)

(1) West German Prostate Center, Cologne, Germany

(2) Department of Urology, Klinik am Ring, Cologne

(3) Department of Radiooncology, Klinik am Ring, Cologne 

Introduction:

We report on local tumor control and correlate this to dosimetric data in patients with localized prostate cancer following 125-iodine LDR monotherapy with a follow-up of up to 7 years.

Material and methods:

Between December 2000 and December 2004,651 patients with localized prostate cancer received perineal seed implantation with real-time dose planning as monotherapy. 501 (77%) patients had a low risk, 148 (23%) a medium risk and 2 were in the high risk group. 599 patients (92%) had a Gleason score of 6 or less, the distribution of clinical stages was 2.4% T1a-b, 68.7% T1c, 27.8% T2a and 1.1% T2b.

Results:

The median follow-up time was 52.7 months (range: 35.3-84.0). 5-year PSA relapse-free survival (PRFS) for low and medium risk patients was 97.5% and 94%, respectively. A median V100 prostate of 98% and a median D90 prostate of 177 Gy were achieved. The D90 prostate was >130/140/150/160 Gy in 98.2/93.9/90.4 and 85.6% of patients. The median D30 urethra was 199.3 Gy and the median D10 rectum was 88.2 Gy.

Patients with PSA recurrence had a median D90 prostate of 167.8 Gy, in patients without recurrence it was 175.9 Gy. Patients were stratified according to PSA-Nadir 0.5 ng/ml (98.2% and 87.6%). A subanalysis of the low-risk group showed a 5-year PRFS for PSA nadir 0.5 ng/ml of 98% and 92%.

Conclusion:

Our investigation showed a correlation of the results after LDR brachytherapy with PSA value, tumor stage, Gleason score and dosimetric quality. In our series, the D90 prostate gland was the strongest prognostic factor as a feature of implant quality.

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