Median 5 Year Follow-up of 125Iodine Brachytherapy as Monotherapy in Men Aged ≤ 55 Years With Favorable Prostate Cancer

ObjectivesTo report the genitourinary (GU) and gastrointestinal (GI) toxicity rates, erectile function preservation, and biochemical outcome (bNED) in men aged ≤ 55 years treated with 125iodine (125I) brachytherapy (BT).MethodsBetween May 1999 and November 2005, 96 men with clinical stage T1-T2 prostate cancer received 125I prostate BT without androgen deprivation or supplemental external radiotherapy. Median age was 53 years (range 45-55). Minimum follow-up was 30 months and median 63 months (range: 30-108). Biochemical failure was defined as “nadir + 2.” GI and GU toxicity are reported using common terminology criteria for adverse events (CTCAE) v3.ResultsOnly 1 patient experienced a biochemical failure; the actuarial 7-year bNED rate is 98.9%. Median nadir is 0.05 ng/mL, reached at 48 months of follow-up. Median 5- and 7-year prostate specific antigen were 0.09 and 0.06 ng/mL, respectively. Grade 2 acute and late GU toxicity rates (urinary frequency, urgency, and/or dysuria) were 9.8% and 10.6%, respectively. Grade 3 GU toxicity (urethral stricture) was observed in 3 men and was corrected with urethral dilatation or transurethral resection. Two (2.2%) patients developed grade 2 GI toxicity (proctitis). Erectile function was preserved in 85 of 91 men with prior good function (93.4%); 41 (45%) used phosphodiesterase-5 inhibitors.ConclusionsMen aged ≤ 55 years treated with 125I prostate BT without androgen deprivation or supplemental external beam radiotherapy experienced excellent bNED rates with low toxicity. Men in this age group should be offered low dose rate prostate BT as an option to consider.