Site Overlay

Definitive brachytherapy in localized prostate cancer–treatment outcomes and prognostic values of prostate specific antigen

By Борис Попщерев

Volume 12, Issue 1

Original Article / Published: December 2024

DOI:

B. Genova

Radiotherapy Department, USBALO, Sofia

Abstract

Brachytherapy in localized prostate cancer is alternative to radical prostatectomy, and the choice should be in accordance with the patient‘s decision when reporting the expected treatment results, complications and quality of life. The reported results of applying low-dose brachytherapy with permanent implant are more long-lasting and indicate a 15-year biochemical control, assessed by PSA values, in 85-88% of treated patients. Data from high dose rate brachytherapy with temporary radioactive implants are with shorter follow-up. The disadvantage of assessing the results of the studies in the treatment of prostate cancer is related to the assessment of the treatment results by biochemical control, and not mortality, as a more categorical indicator. This is due to the average age of the patients, the difficult differentiation of complications from frequently applied androgen deprivation therapy – hormonal treatment, concomitant diseases and the difficulty of distinguishing natural causes of the fatal outcome from specific tumor-related mortality. Prostate-specific antigen (PSA) values determine the prognosis during the course of the disease to a significant extent, as well as in monitoring the disease-free period. After radical prostatectomy, persistence of PSA is an expression of non-radical treatment behavior or undetected distant metastasis. While in radiotherapy and the various methods – external beam or brachytherapy due to the preservation of the parenchyma of the gland and the specific response to ionizing radiation depending on the size of the dose fraction, PSA continues to be detected long after the treatment. The pretreatment-initial level of the tumor marker is also important for this. The serious difficulty of using the marker in the follow-up of radiotherapy results has been demonstrated in numerous retrospective studies comparing local methods such as radical prostatectomy, percutaneous radiotherapy and brachytherapy or combined radiotherapy. The aim of the review is to present the results after different types of brachytherapy in localized prostate cancer and the data available in the literature on the follow-up of patients after brachytherapy with PSA values, their kinetics over time and their prognostic significance.

References

  1. de Rooij M, Hamoen EH, Witjes JA et al. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol. 2016 Aug;70(2):233-45.
  2. Martin RM, Donovan JL, Turner EL, et al. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial. JAMA. 2018;31 (9):883-895.
  3. Aronowitz, J.N. 2002. Dawn of prostate brachytherapy: 1915–1930. Int J Radiat Oncol Biol Phys 54:712–8.
  4. Fornage, B.D., Touche, D.H., Deglaire, M., Faroux, M.J., and Simatos, A. 1983. Real-time ultrasound-guided prostatic biopsy using a new transrectal linear-array probe. Radiology 146:547–8.
  5. Ragde H, Grado GL, Nadir BS. Brachytherapy for clinically localized prostate cancer: thirteen-year disease-free survival of 769 consecutive prostate cancer patients treated with permanent implants alone. Arch Esp Urol. 2001 Sep;54(7):739-47.
  6. Zelefsky MJ, Kuban DA, Levy LB, Potters L, Beyer DC, Blasko JC, et al. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 2007 Feb1;67(2):327-333.
  7. Polo A. Brachytherapy for prostate cancer in J.Venselaar (2013) Comprehensive brachytherapy Physical and clinical aspects (pp 271-293) , Boca Raton, FL:CRC/Taylor & Francis Group.
  8. Sylvester JE, Grimm PD, Wong J, et al. Fifteen-year biochemical relapsefree survival, cause-specific survival, andoverall survival following I(125)prostate brachytherapy in clinically localized prostate cancer: Seattle experience. Int J Radiat Oncol Biol Phys 2011;81:376–381.
  9. Stone NN, Stone MM, Rosenstein BS, et al. Influence of pretreatment and treatment factors on intermediate to long-term outcome after prostate brachytherapy. J Urol 2011;185:495–500.
  10. Potters L, Morgenstern C, Calugaru E, Fearn P, Jassal A, Presser J, Mullen E. 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol. 2008 May;179(5 Suppl):S20-4.
  11. Peinemann F, Grouven U, Hemkens LG, Bartel C, Borchers H, Pinkawa M, Heidenreich A, Sauerland S.Low-dose rate brachytherapy for men with localized prostate cancer. Cochrane Database Syst Rev. 2011 Jul 6 (7):CD008871.
  12. Yinkun Wang, MSc, Nicola J. Nasser, MD, PhD, Jette Borg, PhD, and Elantholi P. Saibishkumar, MBBS, MD, FRCPC. Evaluation of the dosimetric impact of loss and displacement of seeds in prostate low-dose-rate brachytherapy. J Contemp Brachytherapy. 2015 Jun; 7(3): 203–210.
  13. Galalae RM, Kovács G, Schultze J, et al. Long-term outcome after elective irradiation of the pelvic lymphatics andlocal dose escalation using high-dose-rate brachytherapy forlocally advanced prostate cancer. Int J Radiat Oncol Biol Phys. 2002;52:81–90.
  14. Mate TP, Gottesman JE, Hatton J, et al. High dose-rate afterloading Ir-192 prostate brachytherapy: feasibility report. Int J Radiat Oncol Biol Phys. 1998;41:525–533.
  15. Demanes DJ, Martinez AA, Ghilezan M, et al. Highdose-rate monotherapy: safe and effective brachytherapy for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2011;81:1286–92.
  16. Zamboglou N, Tselis N, Baltas D, et al. High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results. Int J Radiat Oncol Biol Phys. 2013;85:672–8.
  17. Hoskin P, Rojas A, Lowe G, et al. High-dose-rate brachytherapy alone for localized prostate cancer in patients at moderate or high risk of biochemical recurrence. Int J Radiat Oncol Biol Phys.
  18. Barkati M, Williams SG, Foroudi F, et al. High-doserate brachytherapy as a monotherapy for favorable-risk prostate cancer: a Phase II trial. Int J Radiat Oncol Biol Phys. 2012;82:1889–96.
  19. Prada PJ, Jimenez I, González-Suárez H, et al. High-doserate interstitial brachytherapy as monotherapy in one fraction and transperineal hyaluronic acid injection into the perirectal fat for the treatment of favorable stage prostate cancer: treatment description and preliminary results. Brachytherapy. 2012;11:105–10.
  20. Mark RJ, Anderson PJ, Akins RS: Interstitial high-doserate brachytherapy as monotherapy for early stage prostate cancer: Median 8-year results in 301 patients. Brachytherapy 9:S76, 2010.
  21. Martinez AA, Demanes J, Vargas C: High-dose-rate prostate brachytherapy: An excellent accelerated-hypofractionated treatment for favorable prostate cancer. Am J Clin Oncol 33:481-488, 2010.
  22. Hauswald H., Kamrava M., Fallon J., et al. High-dose-rate monotherapy for localized prostate cancer: 10-year results. Int J Radiat Oncol Biol Phys 2016, 94: 667-674.
  23. Yoshioka Y, Suzuki O, Isohashi F: High-dose-rate brachytherapy as monotherapy for intermediate- and highrisk prostate cancer: Clinical results for a median 8-year follow-up. Int J Radiat Oncol Biol Phys 94:675-682, 2016.
  24. Hoskin P, Rojas A, Ostler P: Single-dose high-dose-rate brachytherapy compared to two and three fractions for lo-23. cally advanced prostate cancer. Radiother Oncol 124:56-60, 2017.
  25. Strouthos I, Tselis N, Chatzikonstantinou G, et al. High dose rate brachytherapy as monotherapy for localised prostate cancer. Radiother Oncol 2018, 126: 270-277.
  26. Ghilezan M, Martinez A, Gustason G, et al. High-doserate brachytherapy as monotherapy delivered in two fractions within one day for favorable/intermediate-risk prostate cancer: preliminary toxicity data. Int J Radiat Oncol Biol Phys. 2012;83(3):927-932.
  27. Morton G, McGuffin M, Chung HT, et al. Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy. Radiother Oncol. 2020;146:90-96.
  28. Armstrong S, Tsang Y, Lowe G, et al. Dosimetry of local failure with single dose 19 Gy high-dose-rate brachytherapy for prostate cancer. Radiother Oncol. 2021;157:93-98.
  29. Ghadjar P, Oesch SL, Rentsch CA, et al. Late toxicity and five year outcomes after high-dose-rate brachytherapy as a monotherapy for localized prostate cancer. Radiat Oncol 2014; 9:122.
  30. Parzen JS, Ye H, Gustafson G, et al. Rates of rectal toxicity in patients treated with high dose rate brachytherapy as monotherapy compared to dose-escalated external beam radiation therapy for localized prostate cancer [published online ahead of print, 2020 Mar 31]. Radiother Oncol. 2020;147:123‐129.
  31. Hindson BR, Millar JL, Matheson B. Urethral strictures following high-dose-rate brachytherapy for prostate cancer: analysis of risk factors. Brachytherapy. 2013;12(1):50-55.
  32. Sullivan L, Williams SG, Tai KH, Foroudi F, Cleeve L, Duchesne GM. Urethral stricture following high dose rate rachytherapy for prostate cancer. Radiother Oncol. 2009 May;91(2):232-6.
  33. Grills IS, Martinez AA, Hollander M, et al. High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. J Urol. 2004;171(3):1098-1104. doi:10.1097/01. ju.0000113299.34404.22
  34. Putora PM, Engeler D, Haile SR, Graf N, Buchauer K, Schmid HP, Plasswilm L. Erectile function wing brachytherapy, external beam radiotherapy, or radical
    prostatectomy in prostate cancer patients. Strahlenther Onkol. 2016 Mar;192(3):182-9.
  35. Hinnen KA, Schaapveld M, van Vulpen M et al. Prostate brachytherapy and second primary cancer risk: a competitive risk analysis. J Clin Oncol2011;29(34):4510-5.
  36. Rose TGE, Bachand F, Kim D. QOL comparison of acute side effects from a high dose rate vs. low dose rate brachytherapy boost combined with external beam radiotherapy. Brachytherapy. (2015) 14:S36.
  37. Hathout L, Mahmoud O, Wang Y, et al. A Phase 2 Randomized Pilot Study Comparing High-Dose-Rate Brachytherapy and Low-Dose-Rate Brachytherapy as Monotherapy in Localized Prostate Cancer. Adv Radiat Oncol. 2019;4(4):631-640.
  38. Mottet N. et al. EAU – EANM – ESTRO – ESUR – ISUP – SIOGGuidelines on Prostate cancer. EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam 2022.
  39. Parker C, Castro E, Fizazi K, et al. ESMO Guidelines Committee.Electronic address: clinicalguidelines@esmo.org. Prostatecancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020 Sep;31(9):1119-1134.
  40. National Comprehensive Cancer Network. Prostate cancer. Version 4.2022 https://www.nccn.org/professionals/physician_gls/pdf/prostat e.pdf Accessed May 10, 2022.
  41. Eastham JA, Auffenberg GB, Barocas DA et al: Clinically localized prostate cancer: AUA/ASTRO guideline part II: principlesof active surveillance, principles of surgery and follow-up. JUrol 2022.
  42. Wilt TJ, Jones KM, Barry MJ, et al. Follow-up of Prostatectomyversus Observation for Early Prostate Cancer. N Engl J Med.2017 Jul 13;377(2):132-142.
  43. Perera M, Papa N, Roberts M, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol. 2020;77:403e417.
Volume 11, Issue 1
Article [pdf]

Keywords:

localized prostate cancer,
definitive brachytherapy, follow-up after radiotherapy, PSA kinetics.

How to cite this article:

B Genova Definitive brachytherapy in localized prostate cancer – treatment outcomes and prognostic values of prostate specific antigen; Journal of Endourology and Minimally Invasive
Surgery, 2024; 11(1): 12-21

Corresponding author:

Dr. Boryana Veselinova Genova, USBALO-EAD, Sofia, Radiotherapy clinic. Sofia, 6 „Plovdivsko Pole“ St. Tel. 0885413234


e-mail: boriana.genova@gmail.com