Prospective trial on focal treatment with hemi-
gland brachytherapy in low-risk prostate cancer: 
A negative study

Cristina Gutiérrez; Elena Villafranca; Montse Ferrer; Amaya Sola; Andrea Slocker; Montse Ventura; Ignacio Visus; Francisco Pino; Marta Barrado; Margarita Illas; Dina Najjari; Naiara Fuentemilla; Pablo Araguás; Santiago Pellejero; Olatz Garin

doi:10.5114/jcb.2025.156000

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original paper

Prospective trial on focal treatment with hemi- gland brachytherapy in low-risk prostate cancer: A negative study

Cristina Gutiérrez

^{1, 2}

,

Elena Villafranca

³

,

Montse Ferrer

^{4, 5, 6}

,

Amaya Sola

³

,

Andrea Slocker

¹

,

Montse Ventura

¹

,

Ignacio Visus

³

,

Francisco Pino

¹

,

Marta Barrado

³

,

Margarita Illas

³

,

Dina Najjari

¹

,

Naiara Fuentemilla

³

,

Pablo Araguás

¹

,

Santiago Pellejero

³

,

Olatz Garin

^{4, 5, 6}

Brachytherapy Unit, Institut Català d’Oncologia, Barcelona, Spain
Radiation Oncology Department, Hospital del Mar Barcelona, Spain
Radiation Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
Universitat Pompeu Fabra, Barcelona, Spain

J Contemp Brachytherapy 2025; 17, 5: 307–314

DOI: https://doi.org/10.5114/jcb.2025.156000

Online publish date: 2025/10/31

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AMA

Gutiérrez C, Villafranca E, Ferrer M, et al. Prospective trial on focal treatment with hemi-
gland brachytherapy in low-risk prostate cancer: 
A negative study. Journal of Contemporary Brachytherapy. 2025;17(5):307-314. doi:10.5114/jcb.2025.156000.

APA

Gutiérrez, C., Villafranca, E., Ferrer, M., Sola, A., Slocker, A.,  & Ventura, M. et al. (2025). Prospective trial on focal treatment with hemi-
gland brachytherapy in low-risk prostate cancer: 
A negative study. Journal of Contemporary Brachytherapy, 17(5), 307-314. https://doi.org/10.5114/jcb.2025.156000

Chicago

Gutiérrez, Cristina, Elena Villafranca, Montse Ferrer, Amaya Sola, Andrea Slocker, Montse Ventura,  and Ignacio Visus et al. 2025. "Prospective trial on focal treatment with hemi-
gland brachytherapy in low-risk prostate cancer: 
A negative study". Journal of Contemporary Brachytherapy 17 (5): 307-314. doi:10.5114/jcb.2025.156000.

Harvard

Gutiérrez, C., Villafranca, E., Ferrer, M., Sola, A., Slocker, A., Ventura, M., Visus, I., Pino, F., Barrado, M., Illas, M., Najjari, D., Fuentemilla, N., Araguás, P., Pellejero, S.,  and Garin, O. (2025). Prospective trial on focal treatment with hemi-
gland brachytherapy in low-risk prostate cancer: 
A negative study. Journal of Contemporary Brachytherapy, 17(5), pp.307-314. https://doi.org/10.5114/jcb.2025.156000

MLA

Gutiérrez, Cristina et al. "Prospective trial on focal treatment with hemi-
gland brachytherapy in low-risk prostate cancer: 
A negative study." Journal of Contemporary Brachytherapy, vol. 17, no. 5, 2025, pp. 307-314. doi:10.5114/jcb.2025.156000.

Vancouver

Gutiérrez C, Villafranca E, Ferrer M, Sola A, Slocker A, Ventura M et al. Prospective trial on focal treatment with hemi-
gland brachytherapy in low-risk prostate cancer: 
A negative study. Journal of Contemporary Brachytherapy. 2025;17(5):307-314. doi:10.5114/jcb.2025.156000.

Purpose
To determine whether hemi-gland seed brachytherapy (HGBT) is as effective as whole-gland seed brachytherapy (WGBT) in patients with single-lobe, low-risk and favorable intermediate-risk prostate cancer (PCa).

Material and methods
Phase II clinical trial in patients with low- and favorable intermediate-risk PCa with HGBT. Enrolment took place between 2016 and 2020. All patients (n = 38) underwent HGBT with iodine-125 (125I) seeds. Inclusion criteria: single-lobe prostate cancer, ≤ 2 positive cores in one lobe (≥ 10 core samples), < 50% core invasion, Glea-son ≤ 7 (3 + 4), non-visible or unilaterally visible tumor. Patient-reported expanded prostate cancer index (EPIC-26) questionnaire was administered to assess quality of life (QoL). Treatment outcomes were compared with a historical cohort of patients (n = 700), who underwent transperineal, ultrasound-guided 125I WGBT between 2000 and 2012.

Results
The mean age was 64.9 years (range, 50-78), the mean baseline prostate-specific antigen (PSA) was 6.12 ng/ml (range, 1.53-10), and the mean nadir was 1.4 ng/ml (range, 0.17-4.24). Most patients (37/38) had Gleason 3 + 3. The mean follow-up was 71.4 months (range, 44-93). Seventeen patients developed biochemical relapse, and 14 presented local clinical progression (contralateral, n = 9, ipsilateral + contralateral, n = 4; and regional, n = 1). Salvage therapy was: contralateral low-dose-rate (LDR) BT (n = 6), high-dose-rate (HDR) BT (n = 2), nodal radiation therapy (RT) + hormonotherapy (n = 2), hormonotherapy alone (n = 1), and prostatectomy (n = 1). Thirty-five patients (92.1%) remained alive (12 with biochemical failure) at the final follow-up, while three patients died of other causes. A slight impairment was observed on all EPIC domains (urinary incontinence, urinary obstruction, bowel, sexual, and hormonal summaries). Compared with the WGBT cohort, urinary irritative/obstructive scores were significantly lower (p = 0.002). At 5 years, biochemical relapse-free survival (BRFS) was 54% in the HGBT group vs. 95% in the WGBT cohort.

Conclusions
In this trial, patients treated with hemi-gland brachytherapy had significantly higher biochemical failure and contralateral relapse rates than a historical cohort of patients treated with WGBT. Larger, well-designed clinical trials are needed to better assess the efficacy of HGBT in the treatment of low-risk PCa.

keywords:

Prospective trial on focal treatment with hemi- gland brachytherapy in low-risk prostate cancer: A negative study

quality of life, prostate brachytherapy, patient-reported outcomes, focal brachytherapy, hemi-gland brachytherapy, prospective trial