Prospective study on quality-of-life, toxicity and early outcome of high-dose-rate brachytherapy as an interstitial boost for localized prostate cancer
Derakhshani P^1,2, Neubauer S^1,2, Weise 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

Background and purpose:
We report on the updated outcome, toxicities and quality-of-life (QoL) of patients after high-dose-rate (HDR)-brachytherapy as a boost to external beam radiotherapy (EBR) for intermediate and high risk localized prostate cancer.
Materials and methods:
692 patients were treated in a single institution with HDR-brachytherapy in afterloading-technique as a boost to 3D-conformal EBR (50.4 Gy) between April 2003 and June 2008. Patients were classified as low-risk in 8.1%, intermediate-risk in 40.4% and high-risk in 51.5%. 59% of patients received neoadjuvant or adjuvant androgen deprivation therapy. Patients were followed in terms of PSA-levels, QoL, urinary function and sexual status. Validated questionnaires (IPSS; EORTC QLQ C30, PR25-Prostate-Module, IIEF5) were prospectively administered to all patients before and at 1, 3, 6, 12 and 24 months after treatment.
Results:
Median follow-up of patients was 46 months (10-84 months). Median PSA for intermediate-risk and high-risk groups decreased from initially 12 ng/ml to 0.19 ng/ml after 36 months. 3-year biochemical control rate for hormone naive patients, as defined by the ASTRO, was 85%. Urinary function (before HDR mean IPSS 8.9) worsened at 3, 6 and 12 months after HDR but remained stable (mean IPSS 10.6/9.3/10.3). Urinary bother score (UB) in PR25 dropped from initially 79.2 to 32.8 immediately after HDR and improved significantly over the next 24 months to almost baseline 69.85. There was no change in bowel function (BF) throughout the study period (before HDR score 91.75, after HDR mean score 90.58). General health status (GHS) before HDR was excellent (score 72.41) and showed only slight decrease at all intervals after HDR (mean score 67.25). At 24 months patients reached baseline in GHS with a mean score of 69.84.
Conclusions:
Beside promising biochemical control rates combined HDR-brachytherapy for intermediate and high-risk prostate cancer results in excellent health-related quality of life with minor acute and late complications.