Prospective trial on focal treatment with hemigland brachytherapy in low-risk prostate cancer: A negative study.
[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 pros
- 추적기간 71.4 months
APA
Gutiérrez C, Villafranca E, et al. (2025). Prospective trial on focal treatment with hemigland 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
MLA
Gutiérrez C, et al.. "Prospective trial on focal treatment with hemigland brachytherapy in low-risk prostate cancer: A negative study.." Journal of contemporary brachytherapy, vol. 17, no. 5, 2025, pp. 307-314.
PMID
41340828
Abstract
[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 ( = 38) underwent HGBT with iodine-125 (I) 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 ( = 700), who underwent transperineal, ultrasound-guided I 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, = 9, ipsilateral + contralateral, = 4; and regional, = 1). Salvage therapy was: contralateral low-dose-rate (LDR) BT ( = 6), high-dose-rate (HDR) BT ( = 2), nodal radiation therapy (RT) + hormonotherapy ( = 2), hormonotherapy alone ( = 1), and prostatectomy ( = 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 ( = 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.
[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 ( = 38) underwent HGBT with iodine-125 (I) 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 ( = 700), who underwent transperineal, ultrasound-guided I 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, = 9, ipsilateral + contralateral, = 4; and regional, = 1). Salvage therapy was: contralateral low-dose-rate (LDR) BT ( = 6), high-dose-rate (HDR) BT ( = 2), nodal radiation therapy (RT) + hormonotherapy ( = 2), hormonotherapy alone ( = 1), and prostatectomy ( = 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 ( = 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.