Long-Term Outcomes of Alternative Brachytherapy Techniques for Early Prostate Cancer. Addendum

摘要

All active, potentially curative treatments for clinically localized prostate cancer damage quality of life. Brachytherapy, or radioactive seed implants, theoretically may increase the target radiation dose and thus improve control of cancer. It has been rapidly adopted in the U.S. despite limited long- term published outcomes, in part because of its convenience and apparently attractive toxicity profile. However, our recent survey of brachytherapy patients after longer follow-up found surprisingly frequent urinary incontinence and erectile dysfunction. Retrospective evidence suggests that reducing the radiation dose to the urethra may prevent later urinary incontinence. A recent refinement of conventional brachytherapy technique targets only the peripheral zone of the prostate, sharply reducing the dose to the urethra, and attempts to reduce radiation 'cold spots' by using intraoperative feedback from real-time magnetic resonance imaging (MRI). Using our validated cancer-specific scales, our pilot data suggested that the altered brachytherapy technique had the intended benefit but also unexpected outcomes. We have extended our cohort study of 276 brachytherapy patients and now compare 3- and 24-month outcomes of this technique to standard ultrasounded-guided brachytherapy.