Recent results of HDR brachytherapy in the treatment of localized forms of prostate cancer

Abstract

Background. High levels of prostate cancer incidence require the search for more effective therapy methods. Interstitial brachytherapy is widely used in the treatment of localized prostate cancer. Purpose – to evaluate the current possibilities of HDR brachytherapy using a 60CO source during radiation therapy in treatment of localized prostate cancer. Materials and Methods. 47 patients with stage II–III prostate cancer who received HDR brachytherapy in combination with EBRT (43 patients) or in mono-mode (4 patients) were examined. The low-risk group included 2 patients (4,3%), the moderate-risk group consisted of 25 patients (53,2%), and the high-risk group included 20 patients (42,5%). The initial mean PSA level was 12,9 ng/ml. The volume of the prostate varied from 17,8 to 57 cm3, the average value was 38,4 cm3. In most patients, the tumor size corresponded to T2 (55,3%). Histologically tumors in all cases corresponded to adenocarcinoma. Results. Evaluation of surgical complications showed: macrohematuria – in 23,4% of cases, acute urethritis – in 6,4% of cases, obstruction symptom – in 4,3%. PSA levels were assessed at 2 months after radiation treatment. The tumor marker ranged from 0,07 to 7,81 ng/ml, the average PSA value was 1,79 ng/ml. MRI examination after 3 months showed that regression of tumor foci and reduction of prostate size was observed in (88,8 ± 6,1)% of patients in the low and intermediate risk groups and in (65,0 ± 10,6)% of cases in the high risk group. After combined radiation treatment: dysuric phenomena of the 1st–2nd grade (RTOG) was diagnosed in 16 patients (37,2%), radiation rectitis of the 1st grade was observed in 4 patients (9,3%). A temporary decrease in sexual function was reported in 2 patients (4,2%). 83% of patients overcame the two-year recurrence-free period: (95,7 ± 3,9)% of patients in the low and intermediate risk groups and in (70,0 ± 10,2)% cases in the high risk group Conclusions. Conducting HDR brachytherapy in terms of combined radiation therapy in patients with localized prostate cancer makes it possible to deliver higher doses of radiation to the tumor volume without the increase in radiation toxicity