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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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Interview with Professor Janusz Skowronek
ABS 2015
vol. 9
Original paper

Focal application of low-dose-rate brachytherapy for prostate cancer: a pilot study

S. Sara Mahdavi, Ingrid T. Spadinger, Septimiu E. Salcudean, Piotr Kozlowski, Silvia D. Chang, Tony Ng, Julio Lobo, Guy Nir, Hamid Moradi, Michael Peacock, James Morris

J Contemp Brachytherapy 2017; 9, 3: 197–208
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Purpose: To evaluate the feasibility and to report the early outcomes of focal treatment of prostate cancer using low- dose-rate brachytherapy (LDR-PB).

Material and methods: Seventeen patients were screened with multi-parametric magnetic resonance imaging (mpMRI), 14 of whom proceeded to receive trans-perineal template mapping biopsy (TTMB). Focal LDR-PB was performed on five eligible patients using dual air kerma strength treatment plans based on planning target volumes derived from cancer locations and determined by TTMB. Patient follow-up includes prostate specific antigen (PSA) measurements, urinary and sexual function questionnaires, repeated imaging and TTMB at specific intervals post-treatment.

Results: Feasibility of focal LDR-PB was shown and short-term outcomes are promising. While the detection rate of tumors, a majority of which were low grade GS 3 + 3, was found to be low on mpMRI (sensitivity of 37.5%), our results suggest the potential of mpMRI in detecting the presence of higher grade (GS ≥ 3 + 4), and bilateral disease indicating its usefulness as a screening tool for focal LDR-PB.

Conclusions: Low-dose-rate brachytherapy is a favorable ablation option for focal treatment of prostate cancer, requiring minimal modification to the standard (whole gland) LDR-PB treatment, and appears to have a more favorable side effect profile. Further investigation, in the form of a larger study, is needed to assess the methods used and the long-term outcomes of focal LDR-PB.

dual source strength planning, focal therapy, low-dose-rate brachytherapy, multi-parametric MRI, prostate cancer

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