Oncological and urinary outcomes following low‐dose‐rate brachytherapy with a median follow‐up of 11.8 years

OBJECTIVES: To examine the long‐term oncological outcomes and urological morbidity of low‐dose‐rate prostate brachytherapy (LDRBT) monotherapy using live intraoperative dosimetry planning and an automated needle navigation delivery system for the treatment of men with low and intermediate‐risk prostate cancer. PATIENTS AND METHODS: A prospective database of 400 consecutive patients who underwent LDRBT between July 2003 and June 2015 was retrospectively reviewed to assess urinary side‐effects and biochemical progression, based on the Phoenix definition and also a definition of a prostate‐specific antigen (PSA) level of ≥0.2 μg/L. RESULTS: Minimum patient follow‐up was 5.5 years. The median follow‐up of the entire cohort was 11.8 years. The median (range) PSA level was 6.1 (0.9–17) μg/L and the median Gleason score was 3 + 4. The biochemical relapse‐free survival (RFS; freedom from biochemical recurrence) based on the Phoenix definition was 85.8% (343/400). The RFS using a ‘surgical’ definition of a PSA level of <0.2 μg/L was 71% (284/400). Of the 297 men followed for ≥10 years, prostate cancer‐specific survival (PCSS) was 98% (291/297). Post‐LDRBT urethral stricture developed in 11 men (2.8%, 11/400). For men with ≥10 years of follow‐up, 22 men (7.4%, 22/297) required a pad for either stress or urge urinary incontinence (UI). UI was identified in only 2.2% (one of 46) of men who had a bladder neck incision (BNI) before LDRBT. CONCLUSION: LDRBT is associated with excellent PCSS, with a median follow‐up of 11.8 years. The risk of post‐implantation urethral stricture and UI is low and a pre‐implantation BNI for management of bladder outflow obstruction does not increase the risk of UI or urethral stricture.