Treatment satisfaction remained 85% at ten years after prostate LDR brachytherapy

KEY POINTS

• This observational study evaluated 853 of 893 consecutive patients treated with iodine-125 LDR prostate brachytherapy between 2010 and 2018 who completed baseline EPIC questionnaires. Median age was 70 years, median PSA 7.1 ng/mL, and the cohort included patients across Gleason Grade Groups 1–5 and clinical stages cT1–cT3.
• Treatment varied according to risk group and era. 444 patients received brachytherapy without EBRT and 409 received combined treatment. Monotherapy used 160 Gy with I-125 seeds; combined treatment used 110 Gy LDR brachytherapy followed approximately one month later by 45 Gy in 1.8-Gy fractions. No patient received a hydrogel spacer.
• Satisfaction increased after the early post-treatment period and remained high long term: 65% at 1 month, 79% at 24 months, 86% at 60 months and 85% at 120 months. Dissatisfaction remained only 3–5% throughout follow-up, including 14 of 330 respondents (4%) at ten years. The seven-year biochemical recurrence-free rate was 94.7%, with 48 biochemical recurrences within ten years.
• High satisfaction did not mean absence of persistent symptoms. At ten years, clinically meaningful worsening from baseline was present in 47% of respondents for urinary QOL, 40% for bowel QOL, 49% for sexual QOL and 25% for hormonal QOL. Only 330 of the original 853 patients remained evaluable at this timepoint.
• At two years, impaired urinary (OR 0.43, 95% CI 0.29–0.61) and bowel QOL (OR 0.61, 95% CI 0.43–0.87) were independently associated with lower odds of treatment satisfaction. At five years, impaired urinary (OR 0.30), bowel (OR 0.53) and hormonal QOL (OR 0.44) remained significant, while biochemical recurrence was also strongly associated with lower satisfaction (OR 0.16, 95% CI 0.07–0.39).
• By ten years, bowel QOL was the only measured domain retaining a significant independent relationship with satisfaction, with impaired bowel QOL associated with lower odds of satisfaction (OR 0.43, 95% CI 0.23–0.81). Sexual QOL impairment was not independently associated with treatment satisfaction at two, five or ten years.
• Treatment factors influenced specific domains. Combined EBRT was associated with impaired bowel QOL at two years (OR 1.76, 95% CI 1.17–2.67) and five years (OR 1.57, 95% CI 1.01–2.45), while adjuvant androgen deprivation was associated with worse urinary, sexual and hormonal outcomes at earlier follow-up. The authors caution that attrition may preferentially remove patients with recurrence or poor QOL; the population was entirely Japanese and treatment protocols evolved over the study period.

CLINICAL TAKEAWAY

SOURCE

Brachytherapy