Skip to main content
SpringerLink
Log in

Comparison of outcomes in high-risk prostate cancer patients treated with low-/high-dose-rate brachytherapy plus external beam radiotherapy

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 09 October 2023

This article has been updated

Abstract

Background

Although brachytherapy is a standard treatment option for patients with high-risk prostate cancer, only a few studies have compared low-dose-rate brachytherapy (LDR-BT) and high-dose-rate brachytherapy (HDR-BT). We applied propensity score-based inverse probability treatment weighting (IPTW) to compare oncological outcomes for LDR-BT and HDR-BT.

Methods

We retrospectively assessed prognosis in 392 patients with high-risk localized prostate cancer who had undergone brachytherapy plus external beam radiation. IPTW was applied to adjust the Kaplan–Meier survival analyses and Cox proportional hazards regression analyses, with the goal of minimizing bias from patient background.

Results

The IPTW-adjusted Kaplan–Meier survival analyses showed no statistically significant differences for time to biochemical recurrence, clinical progression, castration-resistant prostate cancer, or death from any cause. The IPTW-adjusted Cox regression analyses also showed that the modality of brachytherapy was not an independent factor in these oncological outcomes. Notably, the two groups differed regarding complications; LDR-BT was associated with a higher rate of acute grade ≥ 2 GU toxicity, and late grade 3 toxicity was noted only in HDR-BT.

Conclusion

Our analysis of long-term outcomes in patients with high-risk localized prostate cancer shows no significant differences in oncological outcomes between LDR-BT and HDR-BT, but some differences in toxicity, and offers patients and clinicians useful information in deciding management strategies for high-risk localized prostate cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Change history

References

  1. Cooperberg MR, Cowan J, Broering JM et al (2008) High-risk prostate cancer in the United States, 1990–2007. World J Urol 26(3):211–218

    Article  PubMed  PubMed Central  Google Scholar 

  2. Moris L, Cumberbatch MG, Van den Broeck T et al (2020) Benefits and risks of primary treatments for high-risk localized and locally advanced prostate cancer: an international multidisciplinary systematic review. Eur Urol 77(5):614–627

    Article  CAS  PubMed  Google Scholar 

  3. Morris WJ, Tyldesley S, Rodda S et al (2017) Androgen suppression combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 98(2):275–285

    Article  PubMed  Google Scholar 

  4. Johnson SB, Lester-Coll NH, Kelly JR et al (2017) Brachytherapy boost utilization and survival in unfavorable-risk prostate cancer. Eur Urol 72(5):738–744

    Article  PubMed  Google Scholar 

  5. Vigneault E, Mbodji K, Magnan S et al (2017) High-dose-rate brachytherapy boost for prostate cancer treatment: different combinations of hypofractionated regimens and clinical outcomes. Radiother Oncol 124(1):49–55

    Article  PubMed  Google Scholar 

  6. Kent AR, Matheson B, Millar JL (2019) Improved survival for patients with prostate cancer receiving high-dose-rate brachytherapy boost to EBRT compared with EBRT alone. Brachytherapy 18(3):313–321

    Article  PubMed  Google Scholar 

  7. National Comprehensive Cancer Network Prostate cancer (version 1. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf). Accessed 1 July 2023

  8. Edge SB, Byrd DR, Compton CC et al (2009) American joint committee on cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  9. Urabe F, Miki K, Kimura T et al (2022) Long-term outcomes of radical prostatectomy versus low-dose-rate brachytherapy in patients with intermediate-risk prostate cancer: propensity score matched comparison. Prostate 81:S1401

    Google Scholar 

  10. Urabe F, Miki K, Kimura T et al (2022) Clinical significance of unfavorable findings in intermediate-risk prostate cancer patients for predicting treatment outcomes after contemporary, dose-escalated multimodal radiotherapy. Prostate 82(4):433–441

    Article  CAS  PubMed  Google Scholar 

  11. Urabe F, Kimura T, Sasaki H et al (2022) How long is long enough to secure disease control after low-dose-rate brachytherapy in combination with other modalities in intermediate-risk, localized prostate cancer? Int J Clin Oncol 27(1):184–193

    Article  CAS  PubMed  Google Scholar 

  12. Konaka H, Egawa S, Saito S et al (2012) Tri-Modality therapy with I-125 brachytherapy, external beam radiation therapy, and short- or long-term hormone therapy for high-risk localized prostate cancer (TRIP): study protocol for a phase III, multicenter, randomized, controlled trial. BMC Cancer 12:110

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Mori K, Sasaki H, Tsutsumi Y et al (2021) Trimodal therapy with high-dose-rate brachytherapy and hypofractionated external beam radiation combined with long-term androgen deprivation for unfavorable-risk prostate cancer. Strahlenther Onkol 197(11):976–985

    Article  PubMed  PubMed Central  Google Scholar 

  14. Roach M 3rd, Hanks G, Thames H Jr et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65(4):965–974

    Article  PubMed  Google Scholar 

  15. Scher HI, Morris MJ, Stadler WM et al (2016) Trial design and objectives for castration-resistant prostate cancer: updated recommendations from the prostate cancer clinical trials working group 3. J Clin Oncol 34(12):1402–1418

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kishan AU, Cook RR, Ciezki JP et al (2018) Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with Gleason score 9–10 prostate cancer. JAMA 319(9):896–905

    Article  PubMed  PubMed Central  Google Scholar 

  17. King MT, Yang DD, Muralidhar V et al (2019) A comparative analysis of overall survival between high-dose-rate and low-dose-rate brachytherapy boosts for unfavorable-risk prostate cancer. Brachytherapy 18(2):186–191

    Article  PubMed  Google Scholar 

  18. Yamazaki H, Masui K, Suzuki G et al (2021) High-dose-rate brachytherapy with external beam radiotherapy versus low-dose-rate brachytherapy with or without external beam radiotherapy for clinically localized prostate cancer. Sci Rep 11(1):6165

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Miki K, Kiba T, Sasaki H et al (2010) Transperineal prostate brachytherapy, using I-125 seed with or without adjuvant androgen deprivation, in patients with intermediate-risk prostate cancer: study protocol for a phase III, multicenter, randomized, controlled trial. BMC Cancer 10:572

    Article  PubMed  PubMed Central  Google Scholar 

  20. Grills IS, Martinez AA, Hollander M et al (2004) High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. J Urol 171(3):1098–1104

    Article  PubMed  Google Scholar 

  21. Hathout L, Mahmoud O, Wang Y et al (2019) A phase 2 randomized pilot study comparing high-dose-rate brachytherapy and low-dose-rate brachytherapy as monotherapy in localized prostate cancer. Adv Radiat Oncol 4(4):631–640

    Article  PubMed  PubMed Central  Google Scholar 

  22. Reynaud T, Hathout L, Carignan D et al (2021) PSA outcomes and late toxicity of single-fraction HDR brachytherapy and LDR brachytherapy as monotherapy in localized prostate cancer: a phase 2 randomized pilot study. Brachytherapy 20(6):1090–1098

    Article  PubMed  Google Scholar 

  23. Major T, Polgár C, Jorgo K et al (2017) Dosimetric comparison between treatment plans of patients treated with low-dose-rate vs. high-dose-rate interstitial prostate brachytherapy as monotherapy: initial findings of a randomized clinical trial. Brachytherapy 16(3):608–615

    Article  CAS  PubMed  Google Scholar 

  24. Tward JD, Jarosek S, Chu H et al (2016) Time course and accumulated risk of severe urinary adverse events after high- versus low-dose-rate prostate brachytherapy with or without external beam radiation therapy. Int J Radiat Oncol Biol Phys 95(5):1443–1453

    Article  PubMed  Google Scholar 

  25. Hindson BR, Millar JL, Matheson B (2013) Urethral strictures following high-dose-rate brachytherapy for prostate cancer: analysis of risk factors. Brachytherapy 12(1):50–55

    Article  PubMed  Google Scholar 

  26. King CR (2002) LDR vs. HDR brachytherapy for localized prostate cancer: the view from radiobiological models. Brachytherapy 1(4):219–226

    Article  PubMed  Google Scholar 

  27. Brenner DJ, Hall EJ (1999) Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys 43(5):1095–1101

    Article  CAS  PubMed  Google Scholar 

  28. Brenner DJ, Martinez AA, Edmundson GK et al (2002) Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. Int J Radiat Oncol Biol Phys 52(1):6–13

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported in part by a Grant, SHIP0804 NCT00664456. We thank Dr. Takaya Sasaki, Department of Nephrology and Hypertension, The Jikei University School of Medicine for critical discussion and revision of this manuscript. English-language editorial support was provided by Lee Seaman of Seaman Medical, Inc., Bellingham WA USA.

Author information

Author notes

  1. Yu Imai and Fumihiko Urabe have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Yu Imai, Fumihiko Urabe, Kosuke Iwatani, Minoru Nakazono, Kojiro Tashiro, Mariko Honda, Kenta Miki & Takahiro Kimura

  2. Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan

    Manabu Aoki

  3. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan

    Shun Sato & Hiroyuki Takahashi

Authors
  1. Yu Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fumihiko Urabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kosuke Iwatani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minoru Nakazono
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kojiro Tashiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mariko Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Manabu Aoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shun Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroyuki Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kenta Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takahiro Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fumihiko Urabe.

Ethics declarations

Conflict of interest

No author has any conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 1170 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Imai, Y., Urabe, F., Iwatani, K. et al. Comparison of outcomes in high-risk prostate cancer patients treated with low-/high-dose-rate brachytherapy plus external beam radiotherapy. Int J Clin Oncol 28, 698–706 (2023). https://doi.org/10.1007/s10147-023-02314-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-023-02314-0

Keywords

Search

Navigation