1. EARLY AND LATE COMPLICATIONS OF PROSTATE LOW DOSE BRACHYTHERAPY
DZNELADZE, MD, PhD
G. BOTCHORISHVILI, MD, PROF.
A. BOCHORISHVILI, MD

2. Prostate Brachytherapy accounts more than one century
Prostate Brachytherapy accounts more than one century. First attempt to treat prostate cancer with radiation was done in 1901 in Paris, France.

3. Different techniques and different radioactive materials had been used to treat prostate cancer

4. Results were controversial until 80th, when ultrasound developed and industry offered transrectal approach and commercially available I125 and P103 seeds.

5. One of the first patients treated by modern Prostate Brachytherapy – Low Dose Radiation

6. LDR - the method we use to treat patients with prostate cancer since 2010

7. Awareness among patients and even among urologists was and is still poor

8. Clinical Stage Gleason Score PSA (ng/ml) Low T1-T2a 2-6 <10
National Comprehensive Cancer Network Risk Group Definitions for Clinically Staged Patients
Clinical Stage Gleason Score PSA (ng/ml)
Low T1-T2a <10
Intermediate T2b-T2c
High T3a-T3b >20
Very High T Node Positive

9. Different kinds of techniques are proposed to plan and insert radioactive materials into the prostate
Pre-treatment planning with previously loaded needles.
Real-Time planning with sophisticated software to plan and insert seeds.
Peripheral planning & inserting the seeds using Mick Applicator.

10. Peripheral planning & inserting the seeds using Mick Applicator

11. Very High T4 Node Positive
National Comprehensive Cancer Network Risk Group Definitions for Clinically Staged Patients
Clinical Stage Gleason Score PSA (ng/ml)
Low T1-T2a <10
Intermediate T2b-T2c
High T3a-T3b >20
Very High T Node Positive

12. We insert transrectal transducer (ultrasound scanner B&K) to visualize prostate, make Real Time planimetry and control seed placement

13. We calculate number of seeds, which is necessary to give to the prostate mPD 144Gy

14. Transperinealy we insert peripheral needles and than implant seeds (using Mick Applicator. Number of seeds implanted peripherally is 75% of that totally prescribed. 25% of seeds we implant internally

15. Seed implantation is checked by X-ray immediately after the procedure

16. From years
51 Patients

17. Hematuria after LDR. TUC. (e)N
Patient
# age
Initial stage
Initial
PSA
Initial PV
Initial GS
Vmax
After5 years PV
Complication
Death 1
68 y
T1c
12,1
35cc
3+3
12ml/s
0,21
22cc
11ml/s no 2
62 y
T2a
15,1
50cc
3+4
10ml/s
0,32
40cc 3
65 y
12,0
49cc
13ml/s
0,5
38cc
16ml/s 4
54 y
14,9
42cc
0,23
15ml/s 5
78 y
9,5
80cc+adt
=50cc
0,65
55cc 6
T2b
19,0
4+3
17ml/s +
10,5
30cc
14ml/s
Hematuria after LDR. TUC. (e) 7
74 y
18,1
45cc ++
0.01
25cc
ADT 8
10,0
48cc
0,16 9
71 y
16,5
44cc
0,2
32cc 10
12,5
0,6
36cc 11
70 y
9,6
13,0ml/s
26cc 12
72 y
15,6
9ml/s
0,1 13
76 y
16,0
0,8
Dysuria (e+l) 14
16,1
+++
9,1
Hormonal Mono
Scheduled salvage RP 15
9,8 16
5,6
0,3 17
6,8
Dysuria (e) 18
8,1
39cc 19
66 y
1,0 20
67 y
0.1 21
59 y
5,0
0,01
20cc 22
7,1
34cc 23
8,0 24
17,8
++++
TURP 25
69 y
10,6
0,9
Proctitis (l) 26
7,6
33cc 27
16,7
+++++ -
Cancer related 28
7,2 29
11,0
37cc

18. 29 Patients
Average age – 68
Highest PSA ng/ml

19. Histological 18 patients Gs6 3+3 (Grade 1)

20. Prostate volume 30-50cc
Urodynamics Vmax lowest 9,1ml/s

21. During 5 years
PSA control every 3 month
TRUS every 6 month

22. Cancer status for 5 years

23. 4 patients cancer recurancy
3 patient – ADT
1 Patient died due to cancer progression
1 patient is waiting for salvage prostatectomy

24. Early Complications Two cases of Urine Retention:
1 case retention
1 case with hematuria

25. Early Complications

26. Late complications

27. Conclusion
Prostate Low Dose Radiation is well accepted method of treatment of prostate cancer in Low and sometime Intermediate Risk patients. This method is recommended by guidelines of Urology and Radiation Oncology associations. We know, that modern approach to manage low risk patients is also active survilance. Though, many patients diagnosed with prostate cancer are anxious and demand to be treated. Prostate Low Dose Brachytherapy is good option to offer to those patients. This is effective method of treatment with comparably less complications. Number of early and late complications, we observed are limited to urine retention, bleeding and inflammation associated with radiation. Any inflammation lasts until radiation expires. Urine retention and bleeding must be treated surgically. Although surgeon must aware, that intervention after radiation should be minimal. We had no case if urine incontinence after implantation. We know, that this is rare complication and in most of the cases it happens after TURP.

28. Thank you for your attention.