Dosimetric analysis of urinary morbidity following prostate brachytherapy (125I vs. 103Pd) combined with external beam radiation therapy.

Abstract

The purpose of this analysis was to correlate isotope selection with the urinary symptoms of patients who received a combination of external beam radiotherapy (EBRT) and a transperineal interstitial permanent prostate brachytherapy (TIPPB) boost with either a (103)palladium ((103)Pd) or a (125)iodine ((125)I) radioisotope. Postimplant dosimetry was performed to evaluate both urethral dose and implant quality. The American Urologic Association (AUA) scores in both the (125)I and (103)Pd groups were similar initially. However, at 1, 3, 6, and 12 months of follow-up, the mean AUA scores for the (125)I and (103)Pd patients were 18 +/- 6 vs. 11 +/- 9, 17 +/- 7 vs. 11 +/- 7, 10 +/- 3 vs. 9 +/- 4, and 14 +/- 8 vs. 7 +/- 5, respectively (P < 0.01). The only significant difference between the postimplant dose-volume histogram (DVH) of the (125)I and (103)Pd implants was the minimum dose that 90% of the urethra received (D(90)). The increased AUA score of the (125)I group was weakly correlated (R(2) = 0.20) with the D(90) dose but that of the (103)Pd patients was not (R(2) = 0.00). This suggests that the higher AUA score of the (125)I patients was not necessarily the result of the higher D(90) dose. Thus, patients who received (103)Pd experienced less urinary morbidity than those implanted with (125)I. We recommend further validating these findings in prospective studies in which the quality of the (125)I and (103)Pd implants can be evaluated.