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Brachytherapy guideline in prostate cancer (high and low dose rate)
Rev Assoc Med B ras 2017; 63(4):293-298 297
loss showed a statistically significant difference in favor of
BT (p<0.001). Meanwhile, none of the questions regarding
irritative or obstructive symptoms that are usually concerns
in BT-treated patients showed a significant difference. In
the sexual domain, questions about the ability to have an
erection (p=0.001), quality of erections (p=0.001), frequen-
cy of erections (p=0.003), waking with morning erection
(p=0.002) and ability to have a satisfactory sexual function
(p=0.003) all favored BT. BT was statistically superior in
the urinary, sexual and patient satisfaction domains. There
was no difference in the other domains. Specifically in rela-
tion to urinary incontinence, more than 80% of patients
treated with BT reported having zero incidence of urinary
incontinence, whereas less than 60% of those undergoing
surgery did the same (A).
The second, an American study, involved 1,201 pa-
tients and 625 female partners prospectively evaluated in
a non-randomized study interviewed by telephone before
and 2, 6, 12 and 24 months after radical prostatectomy,
prostate external beamRT, or LDR-BT.24 The interview was
started before the use of androgen blockade, if any. Reduc-
tion of erectile function was reported by the partner in 44%
of cases treated with radical prostatectomy, 22% of those
treated with external beam RT, and 13% of those treated
with LDR-BT. Analyzing the quality of life charts, specifi-
cally regarding sexual function and urinary incontinence,
the steepest decline in rates in the surgery group compared
to the baseline assessment is clear. Such decline is not rel-
evant in the group treated with BT. It is difficult to compare
the modalities, however, since the author does not report
a statistical comparison between them. This study dem-
onstrated that changes caused by LDR-BT are lighter in
some domains and more relevant in other ones (B).
The third study, Italian, was randomized and includ-
ed 200 participants in the analysis of quality of life scores
(EORTC-QLQ-C30/PR25) between surgical patients and
others submitted to LDR-BT. There were no significant
differences in the domains peculiar to this evaluation tool
(physical, emotional, cognitive and social functions, glob-
al health, fatigue, nausea/vomiting, pain, dyspnea, insom-
nia, lack of appetite, constipation, diarrhea, financial
problems, urinary, intestinal and sexual symptoms) (A).
Specifically for patients undergoing HDR-BT, a single
arm observational series32 analyzed 51 patients using three
scores, analyzed at 2 and 4 weeks, and also at 3, 9, and 12
months. The Functional Assessment of Cancer Therapy-
-Prostate (FACT-P) questionnaire did not show significant
variation in all domains (physical, social, family, emotion-
al and functional well-being). The IIEF index did not show
significant variation, either. The International Prostate
SymptomScore (IPSS), in turn, showed a significant increase
at weeks 2 and 4, but recovery was seen at 3 months (C).
Appendix
Search strategies for MEDLINE
(Prostate Neoplasms [Mesh] OR Prostate Neoplasm OR
Neoplasm, Prostate OR Neoplasms, Prostate OR Tumors,
Prostate OR Prostate Tumors OR Prostate Tumor OR
Tumor, Prostate OR Prostatic Carcinoma, Human OR
Carcinoma, Human Prostatic OR Carcinomas, Human
Prostatic OR Human Prostatic Carcinomas OR Prostatic
Carcinomas, Human OR Human Prostatic Carcinoma
OR Prostatic Neoplasms, Human OR Human Prostatic
NeoplasmOR Human Prostatic Neoplasms OR Neoplasm,
Human Prostatic OR Neoplasms, Human Prostatic OR
Prostatic Neoplasm, Human OR Prostate Cancer OR
Cancer, Prostate OR Cancer of the Prostate OR Cancer
of Prostate) AND (Brachytherapy [MeSH] OR Radioiso-
topes [MeSH] OR Radiotherapy [MeSH] OR Radioisotopes
[MeSH] AND Therapeutics [MeSH] OR Iodine [MeSH]
OR Palladium [MeSH] OR Interstitial [MeSH] OR Per-
manent [MeSH] OR Implant [MeSH])
Conflict of interest
The authors declare no conflict of interest.
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