Poster Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2011

Abstract number 10

A single institution’s experience of cytoreductive regimens prior to prostate brachytherapy.

Roisin Connolly, Galway University Hospital
Aisling Barry,  Galway University Hospital
Frank Sullivan, Galway University Hospital

Aims/ Introduction: Our study aimed to assess the percentage reduction in prostate volume with cytoreductive hormonal manipulation for patients who had prostate volumes of greater than 50mls prior to brachytherapy.

Materials/Methods: Since 2008, Galway University Hospital has treated over 200 patients with prostate brachytherapy. From our hospital records we did a retrospective analysis comparing pre- and post-hormone prostate volumes in 23 patients who required cytoreductive treatment prior to brachytherapy. Therapeutic options used either alone or in combination were a 5-alpha reductase inhibitor (dutasteride), an anti-androgen (biclutamide) and a LHRH analogue (triptorelin). Treatment decisions were made at an individual patient level but in general LHRH analogues were avoided in patients who had moderately enlarged prostates (i.e. 50-75mls).

Results: The greatest percentage volume reduction (median 37.5%) was seen in the triptorelin alone group, with the average pre-treatment volume for these patients being higher, at 67.78, than that of patients whose hormone regimen did not include triptorelin (59.94 ml). Our results indicated that patients whose cytoreductive regimen included triptorelin experienced greater problems with erectile dysfunction than the other groups. Patients who were treated with dutasteride and bicalutamide (n=8) achieved a satisfactory reduction in prostate volume in most cases (median 27.06%), with a shorter duration of treatment than the other groups (median 98 days). Of note, 2 patients did not have any reduction in volume with hormonal treatment.

Conclusion: Our institution recommends the use of combination 5-alpha reductase inhibitor and anti-androgen therapy for volumes of 50-75mls. For those with prostate volumes of above 75mls, we advocate the use of a LHRH analogue alone or in combination.