Clinical use of high dose-rate brachytherapy in treatment of patients with localized prostate cancer and infravesical obstruction

Background. High dose-rate brachytherapy is a new method of interstitial radiation therapy for treatment of localized prostate cancer. The difference from low dose therapy is temporary implantation of radiation sources with targeted high dose-rate irradiation of the affected organ.

Aim. To evaluate 3-year effectiveness and safety of high dose-rate brachytherapy in patients with infravesical obstruction. Materials and methods. Between January of 2017 and December of 2019 at the Central Clinical Hospital “RZD-medicine”, 49 patients  (mean age 67.8 ± 7.5 years) with verified prostate  cancer diagnosis underwent high dose-rate brachytherapy in the regimen of 2 sessions of 15 Gy with ¹⁹²Ir source. The inclusion criteria were disease stage ≤сТ2с, Gleason score ≤7. Patients were divided into 2 groups: 1^st – patients with incidental prostate cancer (n = 21) who previously (more than 6 months ago, mean time 9.4 ± 2.4 months) underwent transurethral prostatectomy; 2^nd – patients with verified prostate cancer (mean prostate volume 56 cm³) and obstructive symptoms without previous transurethral prostatectomy (n = 28).

Results. In both groups, no intraoperative complications were observed. In 6 (28 %) patients of the 1^st group and 2 patients of the 2^nd group, grade II genitourinary toxicity in the form of moderate dysuria and nocturia was observed. Acute gastrointestinal  toxicity was observed in 3 (14 %) patients of the 1^st group, in the 2^nd group such complications were absent. In the 2^nd group during the postoperative period after the 2^nd session, 4 patients (14 %) experienced acute urinary retention requiring cystostomy.

Conclusion. High dose-rate brachytherapy is a safe and effective radical treatment method for patients with localized prostate cancer with obstructive symptoms who have contraindications for surgical treatment.

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