Strahlentherapie und Onkologie

, Volume 193, Issue 9, pp 707–713 | Cite as

125I brachytherapy in younger prostate cancer patients

Outcomes in low- and intermediate-risk disease
  • Isabelle KindtsEmail author
  • Karin Stellamans
  • Ignace Billiet
  • Hans Pottel
  • Antoon Lambrecht
Original Article



To evaluate local recurrence in younger men treated with low-dose-rate (LDR) 125I brachytherapy (BT) for localized prostate cancer.

Patients and methods

A total of 192 patients (≤65-years-old) were treated with LDR 125I-BT ± hormone therapy. Local failure was defined as any prostate-specific antigen (PSA) rise leading to salvage treatment or biochemical failure according to the Phoenix definition. A bounce was defined as a rise in the nadir of ≥0.2 ng/mL followed by spontaneous return. Proportions were compared using Fisher’s exact tests; continuous variables using the unpaired t-test or its non-parametric equivalent. Cox proportional hazards models were applied for multivariable survival analysis.


Median follow-up was 66 months. The 5‑year local recurrence-free survival was 96.1%. Biopsy-proven local recurrence developed in 13 patients, 4 had a Phoenix-defined recurrence at the last follow-up. Androgen deprivation therapy was started in 1 patient without proven recurrence. Univariable risk factors for local recurrence were: at least 50% positive biopsies, intermediate risk, treatment with neoadjuvant hormone therapy, low preimplantation volume receiving 100% of the prescribed dose, and no bounce development. Hormone-naïve patients not attaining a PSA value <0.5 ng/mL during follow-up also had a higher risk of local recurrences. Cox regression demonstrated that the variables “at least 50% positive biopsies” and “bounce” significantly impacted local failure (hazard ratio, HR 1.02 and 11.59, respectively). A bounce developed in 70 patients (36%). Younger patients and those treated with a lower activity per volume had a higher chance of developing a bounce in the Cox model (HR 0.99 and 0.04, respectively).


For younger men, LDR BT is a valid primary curative treatment option in low-risk and is to consider in intermediate-risk localized prostate cancer.


Risk factors Prostate-specific antigen Radiotherapy Brachytherapy 

125Iod-Brachytherapie bei jungen Patienten mit Prostatakarzinom

Behandlungsergebnisse bei Low- und Intermediate-risk-Erkrankung



Bestimmung der Lokalrezidivrate bei jüngeren Patienten mit lokalisiertem Prostatakarzinom nach Low-Dose-Rate-(LDR-)Brachytherapie (BT) mit 125Iod-Seed-Implantaten.

Patienten und Methoden

Mit LDR-125Iod-BT ± Hormontherapie wurden 192 Patienten (≤65 Jahren) behandelt. Als Lokalrezidiv galt ein PSA-Anstieg, der zur Salvage-Therapie führte, oder ein biochemisches Rezidiv nach Phoenix-Definition. Als PSA-Wiederanstieg war eine Nadir-Erhöhung ≥0,2 ng/ml, gefolgt von spontaner Rückgang definiert. Verhältnisse wurden mit dem exakten Fisher-Test und kontinuierliche Variablen mit dem ungepaarten t-Test oder einer nichtparametrischen Methode verglichen. Mit multivariater Cox-Regressionsanalyse wurde der Einfluss von Kofaktoren untersucht.


Das mediane Follow-up betrug 66 Monate. Das lokalrezidivfreie 5‑Jahres-Überleben betrug 96,1 %. Ein histologisch nachgewiesenes Lokalrezidiv entwickelten 13 Patienten; ein Rezidiv nach Phoenix hatten bei der letzten Untersuchung 4 Patienten. Ein Patient ohne positive Prostatabiopsie bekam eine Hormontherapie. Univariate Risikofaktoren für ein Lokalrezidiv waren: mindestens 50 % positive Biopsien, intermediäres Risiko, Behandlung mit neoadjuvanter Hormontherapie, geringe Prostatavolumenabdeckung mit 100 % der vorgeschriebenen Dosis und kein PSA-Wiederanstieg. Hormonnaive Patienten, die keinen PSA-Wert <0,5 ng/ml im Follow-up erzielten, hatten ein höheres Lokalrezidivrisiko. Die Cox-Regression ergab, dass „mindestens 50 % positive Biopsien“ und „kein PSA-Wiederanstieg“ die lokale Kontrolle signifikant beeinflussen (Hazard Ratio [HR] je 1,02 und 11,59). Einen Wiederanstieg zeigten 70 Patienten (36 %). Jüngere Patienten und jene, die mit einer geringeren Aktivität pro Volumen behandelt wurden, hatten ein höheres Risiko für einen Wiederanstieg (je HR 0,99 und 0,04).


LDR-BT ist eine effektive kurative Behandlungsmethode für junge Männer mit Low-risk-Prostatakarzinom und ist auch bei intermediärem Risiko zu erwägen.


Risikofaktoren Prostataspezifisches Antigen Strahlentherapie Brachytherapie 



The authors acknowledge gratefully F. Ameye, B. Bamelis, M. D’Hoedt, S. Huybrechts, W. Kerkhaert, K. Lesage, P. Schoonooghe, D. Vandervaeren, P. Verleyen, P. Vossaert, and P. Werbrouck for their cooperation.

Conflict of interest

I. Kindts, K. Stellamans, I. Billiet, Hans Pottel, and A. Lambrecht declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Isabelle Kindts
    • 1
    Email author
  • Karin Stellamans
    • 1
  • Ignace Billiet
    • 2
  • Hans Pottel
    • 3
  • Antoon Lambrecht
    • 1
  1. 1.Department of Radiation OncologyAZ Groeninge HospitalKortrijkBelgium
  2. 2.Department of UrologyAZ Groeninge HospitalKortrijkBelgium
  3. 3.Biostatistics, Faculty of MedicineCatholic University Leuven KulakKortrijkBelgium

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