UroToday - In 2004, we reported our observations on early toxicity in patients treated with an inversely planned high-dose rate (HDR) brachytherapy boost. In this study, we present our most recent observations on biochemical and pathological controls for patients with localized prostate cancer at intermediate and high risk of recurrence.

Between 1999 and 2006, 206 patients with localized prostate adenocarcinoma were treated at L'Hôtel-Dieu de Québec with external beam radiation for 40-44 Gy at 2Gy/fraction followed by an HDR-Iridium192 brachytherapy boost, most of them receiving 2 fractions of 10 Gy.

The use of an HDR brachytherapy boost with inverse planning gives excellent 5-year biochemical recurrence-free survival (bRFS) of 96% (ASTRO and Houston consensus definitions). Furthermore, the 2-year negative prostate biopsy rate (91.5%) is excellent. There is also a strong correlation between negative biopsies and 5-year bRFS. These excellent results should be compared with high dose IMRT to prostate in a randomised study.

To our knowledge, we are the first to describe PSA bounces in patients treated with an HDR brachytherapy boost. A PSA bounce defined as nadir plus 2 ng/ml followed by a spontaneous PSA decrease is observed in 10% of patients. Careful management of PSA elevation during the follow-up is suggested, especially in the first two years of treatment, because incidence of PSA bounce is high with this modality, even if the last Phoenix consensus definition of biochemical recurrence is used.

Eric Vigneault, MD, FRCPC, MSc and François Bachand, MD as part of Beyond the Abstract on UroToday

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