Permanent interstitial brachytherapy for prostate cancer implenting prostatic artery embolization
PD-0566
Abstract
Permanent interstitial brachytherapy for prostate cancer implenting prostatic artery embolization
Authors: Hathal Haddad1, Horst Hermani1, Peter Bischoff2, Herbert Hanitzsch3, Albert Heidrich3, Andreas Schaefer4, Attila Kovács2, Michael Pinkawa1
1Mediclin Robert Janker Clinic, Department of Radiation Oncology, Bonn, Germany; 2Mediclin Robert Janker Clinic, Department of Interventional and Diagnostic Radiology and Neuroradiology, Bonn, Germany; 3Mediclin Robert Janker Clinic, Department of Urology, Bonn, Germany; 4MediClin Robert Janker Clinic, Department of Interventional and Diagnostic Radiology and Neuroradiology, Bonn, Germany
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Purpose or Objective
Indication for permanent interstitial brachytherapy (PIB) can be limited by prostate volume, commonly decreased using neoadjuvant hormonal therapy. Volume
changes and initial clinical results focusing on patients treated with prostatic artery embolization (PAE) were evaluated in this study
Material and Methods
A group of 102 consecutive patients were treated with permanent interstitial brachytherapy (PIB), 13 patients received a neoadjuvant PAE (median 12 weeks before PIB) in case of large prostate volume >60cm³ and moderate to severe urinary problems
Results
Patients after PAE were treated with significantly larger prostate volumes (52±11 cm³ vs. 39±11 cm³; p<0.01; 66±17cm³ before PAE), but larger volume reductions to 44±10 cm³ vs. 35±10 cm³ was found at day 30 (p<0.05). International Prostate Symptom Score (IPSS) decreased significantly from 13±5 before PAE to 7±4 after PAE; p<0.01. Initial PSA and first PSA after PIB were similar for patients with vs. without PAE (5.9±2.9 ng/ml vs. 6.2±2.8 ng/ml and 1.5±0.8 ng/ml vs. 1.9±1.5 ng/ml).
However, PSA 12 months after PIB was significantly lower after PAE (0.4±0.3 ng/ml vs. 0.8±0.6 ng/ml; p=0.03). Four patients without prior PAE needed an intervention
following urinary retention – transurethral resection of the prostate (TURP) in 3 cases and PAE in a single case. Urinary incontinence resulted in 2 cases following TURP
Conclusion
PAE can be successfully applied to decrease prostate volume and reduce urinary symptoms before PIB or as a treatment for urinary retention after PIB. A significantly lower PSA is promising for improved long-term cancer control