Journal of Contemporary Brachytherapy

Temporary prostate brachytherapy alone or as boost: Single-institution experience on dose-response assessment focusing on sphincter-related urinary toxicity

Lukas Goderbauer 1, 2
,
Vratislav Strnad 1, 2
,
Christoph Bert 1, 2
,
Dorota Lubgan 1, 2, 3
,
Claudia Schweizer 1, 2
,
Rainer Fietkau 1, 2
,
Stefanie Corradini 1, 2
,
Ricarda Merten 1, 2
,
Andre Karius 1, 2

  1. Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany

  2. Comprehensive Cancer Center Erlangen EMN (CCC Erlangen-EMN), Erlangen, Germany

  3. Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany

J Contemp Brachytherapy 2026

DOI: https://doi.org/10.5114/jcb.2026.164587
Data publikacji online: 2026/09/10
Article file
Temporary prostate brachytherapy.pdf
  1. Bray F, Laversanne M, Sung H et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74: 229-263.
  2. Sung H, Ferlay J, Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209-249.
  3. Gandaglia G, Leni R, Bray F et al. Epidemiology and prevention of prostate cancer. Eur Urol Oncol 2021; 4: 877-892.
  4. Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer: a systematic review. Adv Urol 2009; 2009: 327945.
  5. Viani GA, Arruda CV, Assis Pellizzon AC, et al. HDR brachytherapy as monotherapy for prostate cancer: A systematic review with meta-analysis. Brachytherapy 2021; 20: 307-314.
  6. Zaorsky NG, Davis BJ, Nguyen PL et al. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14: 415-439.
  7. Schubert P, Strnad V, Weißmann T et al. Protocol-based CT-guided brachytherapy for patients with prostate cancer and previous rectal extirpation – a curative approach. Strahlenther Onkol 2025; 201: 20-26.
  8. Esteves S, Moschini V, Martins J et al. Permanent seed brachytherapy for prostate cancer: Monotherapy, combined, and salvage approaches remain effective and well-tolerated options. J Contemp Brachytherapy 2026; 18: 23-31.
  9. Hjälm-Eriksson M, Nilsson S, Brandberg Y et al. High rate of local control and cure at 10 years after treatment of prostate cancer with external beam radiotherapy and high-dose-rate brachytherapy: a single centre experience. Acta Oncol Stockh Swed 2021; 60: 1301-1307.
  10. Hofer MD, Gonzalez CM. Management of radiation-induced urethral strictures. Transl Androl Urol 2015; 4: 66-71.
  11. Zwaans BMM, Carabulea AL, Bartolone SN, et al. Voiding defects in acute radiation cystitis driven by urothelial barrier defect through loss of E-cadherin, ZO-1 and Uroplakin III. Sci Rep 2021; 11: 19277.
  12. Lobo N, Kulkarni M, Hughes S, et al. Urologic complications following pelvic radiotherapy. Urology 2018; 122: 1-9.
  13. Hughes M, Caza T, Li G, et al. Histologic characterization of the post-radiation urethral stenosis in men treated for prostate cancer. World J Urol 2020; 38: 2269-2277.
  14. Helissey C, Cavallero S, Brossard C, et al. Chronic inflammation and radiation-induced cystitis: molecular background and therapeutic perspectives. Cells 2020; 10: 21.
  15. Wang W, Zhang F, Yuan S. Clinical guidelines for the prevention and treatment of radiation-induced bladder injury. Precis Radiat Oncol 2024; 8: 4-13.
  16. Barlas IS, Aybal HC, Duvarci M et al. Revisiting the external urethral sphincter: new anatomical insights from a human cadaver study. World J Urol 2024; 42: 496.
  17. Dirk K, Rourke KF. Health-related quality of life in patients with urethral stenosis after radiation treatment for prostate cancer. Urology 2024; 185: 109-115.
  18. Register SP, Kudchadker RJ, Levy LB et al. An MRI-based dose--reponse analysis of urinary sphincter dose and urinary morbidity after brachytherapy for prostate cancer in a phase II prospective trial. Brachytherapy 2013; 12: 210-216.
  19. Chyrek AJ, Hetnał M, Kukiełka A et al. Polish Brachytherapy Society clinical recommendations and expert consensus on radical high-dose-rate brachytherapy for prostate cancer. J Contemp Brachytherapy 2026; 18: 3-18.
  20. McLaughlin PW, Troyer S, Berri S et al. Functional anatomy of the prostate: Implications for treatment planning. Int J Radiat Oncol Biol Phys 2005; 63: 479-491.
  21. LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Biol Phys 1995; 31: 1049-1091.
  22. The SciPy community: scipy.stats.fisher_exact. Link: https://docs.scipy.org/doc/scipy/reference/generated/scipy.stats.fisher_exact.html (accessed at 2026/07/02).
  23. Guerrero M, Li XA. Halftime for repair of sublethal damage in normal bladder and rectum: an analysis of clinical data from cervix brachytherapy. Phys Med Biol 2006; 51: 4063-4071.
  24. Lettmaier S, Lotter M, Kreppner S et al. Long term results of a prospective dose escalation phase-II trial: interstitial pulsed-dose-rate brachytherapy as boost for intermediate- and high-risk prostate cancer. Radiother Oncol J Eur Soc Ther Radiol Oncol 2012; 104: 181-186.
  25. D’Amico AV, Desjardin A, Chung A et al. Assessment of outcome prediction models for patients with localized prostate carcinoma managed with radical prostatectomy or external beam radiation therapy. Cancer 1998; 82: 1887-1896.
  26. Moll M, Magrowski Ł, Mittlböck M et al. Biochemical control in intermediate- and high-risk prostate cancer after EBRT with and without brachytherapy boost. Strahlenther Onkol 2025; 201: 11-19.
  27. Trofymov A, Bschleipfer T, Aigner T et al. Intensity modulated radiation therapy in prostate cancer—Better survival with higher total dose? Strahlenther Onkol 2025; 201: 837-845.
  28. Karius A, Lotter M, Kreppner S et al. Permanent LDR prostate brachytherapy: Comprehensive characterization of seed-dynamics within the prostate on a seed-only level. Brachytherapy 2022; 21: 635-646.
  29. Xu Z, Arsenault TH, Traughber B et al. Dose uncertainty due to needle-tip localization error in prostate seed implantation. J Contemp Brachytherapy 2022; 14: 582-589.
  30. 30. Karius A, Schweizer C, Strnad V et al. Seed-displacements in the immediate post-implant phase in permanent prostate brachytherapy. Radiother Oncol J Eur Soc Ther Radiol Oncol 2023; 183: 109590.
  31. Martell K, Mendez LC, Chung HT et al. Results of 15 Gy HDR-BT boost plus EBRT in intermediate-risk prostate cancer: Analysis of over 500 patients. Radiother Oncol J Eur Soc Ther Radiol Oncol 2019; 141: 149-155.
  32. Kittel JA, Reddy CA, Smith KL et al. Long-term efficacy and toxicity of low-dose-rate 125I prostate brachytherapy as monotherapy in low-, intermediate-, and high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2015; 92: 884-893.
  33. Ishiyama H, Kamitani N, Kawamura H et al. Nationwide multi-institutional retrospective analysis of high-dose-rate brachytherapy combined with external beam radiotherapy for localized prostate cancer: An Asian Prostate HDR-BT Consortium. Brachytherapy 2017; 16: 503-510.
  34. Amini A, Jones BL, Jackson MW et al. Survival outcomes of combined external beam radiotherapy and brachytherapy vs. brachytherapy alone for intermediate-risk prostate cancer patients using the National Cancer Data Base. Brachytherapy 2016; 15: 136-146.
  35. Ka K, Schiappa R, Terlizzi M et al. Outcomes following brachytherapy boost for intermediate- and high-risk prostate cancer: A retrospective bicenter study by the SFRO brachytherapy group. Radiother Oncol 2023; 180: 109460.
  36. Blanchard P, Ménard C, Frank SJ. Clinical use of magnetic resonance imaging across the prostate brachytherapy workflow. Brachytherapy 2017; 16: 734-742.
  37. Spohn SKB, Aebersold DM, Albrecht C et al. Biomarkers in prostate cancer: current status and future directions in radiotherapy—statement from the Prostate Cancer Working Group of the German Society of Radiation Oncology (DEGRO). Strahlenther Onkol 2025; 201: 759-766.
  38. Sanmamed N, Adleman J, Berlin A et al. Acute toxicity and health-related quality of life outcomes of localized prostate cancer patients treated with magnetic resonance imaging-guided high-dose-rate brachytherapy: A prospective phase II trial. Brachytherapy 2023; 22: 58-65.
  39. Cesaretti JA, Stone NN, Stock RG. Urinary symptom flare following I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys 2003; 56: 1085-1092.
  40. Rana Z, Cyr RA, Chen LN et al. Improved irritative voiding symptoms 3 years after stereotactic body radiation therapy for prostate cancer. Front Oncol 2014; 4: 290.
  41. Holm A, Cordoba G, Siersma V et al. Development and validation of a condition-specific diary to measure severity, bothersomeness and impact on daily activities for patients with acute urinary tract infection in primary care. Health Qual Life Outcomes 2017; 15: 57.
  42. Nuijens AC, Oei AL, Bouhuijs A et al. A comparison between patient- and physician-reported late radiation toxicity in long-term prostate cancer survivors. Cancers 2022; 14: 1670.
  43. Rodrigues G, Bauman G, Lock M et al. Psychometric properties of a prostate cancer radiation late toxicity questionnaire. Health Qual Life Outcomes 2007; 5: 29.
Copyright: © 2026 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
SUBMIT YOUR PAPER
Share
without publication fees
Indexed in
pubmed
Integrated with
integrated with publons
Editorial Policies
Sarajevo Declaration on Integrity and Visibility of Scholarly Publications