KEY POINTS
- This updated long-term analysis reported outcomes after high-dose-rate brachytherapy monotherapy for clinically localized prostate cancer; 351 consecutive patients were treated, and 201 were eligible for the current analysis.
- The protocol used 2 implants separated by 14 days, each delivering 2 fractions of 9.5 Gy, for a total physical dose of 38 Gy in 4 fractions.
- Median follow-up was 157.8 months; biochemical control was 94% at 60 months, 90% at 120 months, and 86% at 158 months.
- Biochemical control at 158 months differed by risk group: 94% for low-risk, 85% for intermediate-risk, and 71% for high-risk disease.
- Late toxicity was limited: 8 patients (3.9%) developed grade 2–3 lower urinary tract symptoms, 4 patients (2%) developed grade 3 gastrointestinal toxicity, and no grade 4 or higher acute or late toxicities were reported.
CLINICAL TAKEAWAY
These mature data support high-dose-rate brachytherapy monotherapy as a durable definitive option for selected patients with localized prostate cancer, especially low- and intermediate-risk disease. The high-risk results are less persuasive, partly because of the risk of occult extraprostatic disease and the lack of systematic modern prostate-specific membrane antigen positron emission tomography staging. The main limitation is that this is a retrospective single-arm series with substantial loss to follow-up and non-uniform androgen deprivation therapy use.