Proffered Presentations Archive

UK & Ireland Prostate Brachytherapy Conference 2024

Abstract number 18

HDR brachytherapy boost in Gleason 9-10 prostate cancer

Tovey H University Hospitals of Leicester NHS Trust 

Panades M, Fernandez-Ots A, Chadwick E, Arias C, Sreenivasan T 

United Lincolnshire Hospitals NHS Trust 

Purpose: A retrospective cohort study performed by Kishan et al [1] demonstrated that in Gleason 9-10 prostate cancer, the use of a brachytherapy boost (HDRB) led to better outcomes than either surgery or external beam radiotherapy (EBRT) alone. We completed an audit of Gleason 9-10 prostate cancer treated at United Lincolnshire Hospitals NHS Trust to assess outcomes from patients treated with HDRB versus EBRT at our centre. 

Methods: A dataset of 4254 patients receiving prostate radiotherapy at ULH between 2004 and 2023 was used. From this we selected patients with Gleason 9-10 prostate cancer, staged as T1-4 N0 M0 treated with radical radiotherapy between 2009 and 2018. This included patients treated with EBRT and HDRB. 

Results: 40 HDRB patients and 105 EBRT patients meeting inclusion criteria were identified. The median age was for the HDRB and EBRT cohorts was 69.5 and 75.0 years respectively. PSA readings were higher in the EBRT cohort (50% measuring over 20, versus 28% in the HDR cohort). The majority of patients treated had T3 disease (65% in the HDR cohort versus 61% in the EBRT cohort). The Gleason scores (whether 4+5, 5+4 or 5+5) were similar between the two cohorts. A higher proportion of patients were alive and disease free in the HDR cohort (58% versus 36% in the EBRT cohort). In the EBRT cohort there was a higher proportion of deaths from causes other than prostate cancer (30% versus 10% in the HDR cohort). 

Conclusion: Our local practice shows that patients treated with an HDRB are more likely to be alive and disease free. Increased deaths from causes other than prostate cancer in patients treated with EBRT alone reflect the older age and increased comorbidities of these patients. Whilst outcome metrics are not equivalent, a similar trend towards better results seems to match published evidence. 

References: 

1. Kishan AU, Cook RR, Ciezki JP, Ross AE, Pomerantz MM, Nguyen PL, et al. Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer. JAMA [Internet]. 2018 Mar 6 [cited 2021 Apr 15];319(9):896.