Low-dose rate brachytherapy of the prostate in elderly patients

Purpose. This study evaluated the biochemical disease-free survival (bDFS) rate, overall survival rate (OS) and toxicity after low-dose rate I-125 permanent-implant prostate brachytherapy (LDR-BRT) in elderly patients affected by prostate cancer. Methods and materials. Patients aged >= 65 years with a diagnosis of prostate cancer and treated at our institution were retrospectively evaluated. All patients received LDR-BRT as monotherapy; the prescribed dose was 145 Gy to the prostate. Patients were stratified according to the National Comprehensive Cancer Network (NCCN) recurrence risk groups. Biochemical failure was defined according to the American Society of Therapeutic Radiology and Oncology (ASTRO) criteria. The Radiation Therapy Oncology Group (RTOG) scale was used for toxicity. The bDFS was calculated from implant date to biochemical recurrence. Results. Between June 2003 and December 2008, 80 elderly patients with a median age of 75 (range, 65-86) years were treated with LDR-BRT: 51 low risk (64%), and 29 intermediate risk (36%). Over a median follow-up period of 53 (range, 28-94) months, the global actuarial 5-year bDFS rate was 91.3% and the 5-year OS was 95%. Toxicity was mild: late grade-3 genitourinary toxicity was observed in only four patients (5%). Conclusions. Our data suggest that LDR-BRT is effective and safe as monotherapy in elderly patients.