Prospective comparison of PSA kinetics following two different prostate cancer brachytherapy planning methods: Preoperative and real-time intraoperative dosimetry planning

Abstract Objectives Preoperative planning (PP) and intraoperative planning (IoP) are established125 I-brachytherapy techniques for the treatment of localized prostate cancer. We prospectively compared the effects of each method on reducing PSA levels. Materials and methods One hundred eighty patients treated with brachytherapy as monotherapy without neoadjuvant androgen deprivation therapy or external beam radiation using PP (75) or IoP (105) methodologies and with ≥5 years of follow-up were included in the study. CT-based dosimetry was calculated 1 month postoperatively. PSA was obtained every 3 months for the first year and semiannually thereafter. Available PSA and dosimetric data from both groups were analyzed and compared. Results At 5 years after brachytherapy, the probability of having a nadir PSA value < 0.5 ng/ml was 90% in the IoP group compared with 60% in the PP group ( P < 0.0001). The rate of PSA decline was 3-fold faster in the IoP group than in the PP group. Dosimetry results highly favored the IoP method: mean V100 (%) and D90 (Gy) were 95 and 180 vs. 60 and 81 ( P < 0.001), respectively. Conclusions Our initial finding of highly superior postimplant CT dosimetry calculations of the IoP method are now substantiated by the biochemical favorable results (PSA kinetics) of this method.