High-dose-rate (HDR) prostate brachytherapy is associated with low genitourinary toxicity rates and appears to be safe even for men with greater baseline urinary symptoms, according to investigators.

Pretesh R. Patel, MD, of the Winship Cancer Institute of Emory University in Atlanta, and colleagues studied 95 men who underwent the treatment at their institution. They divided the men into 2 groups according to baseline International Prostate Symptom Score (IPSS): less than 15 (79 patients) and 15 or higher (16 patients) and compared quality of life outcomes in the groups. The investigators calculated scores based on patient-reported symptoms as measured using the IPSS and Expanded Prostate Index for Prostate Cancer—Clinical Practice (EPIC-CP) instruments. EPIC-CP is divided into subdomains, including urinary incontinence and urinary irritability and obstructive symptoms.

The median follow-up was 23 months in the IPSS less than 15 group and 16 months in the IPSS 15 or higher group. The median prostate volume was 46.3 and 45.4 cc, respectively. Most patients in both groups had intermediate-risk disease.

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At baseline, IPSS and incontinence and urinary irritation/obstruction scores were significantly greater in the IPSS 15 or higher group than the IPSS less than 15 group, Dr Patel’s team reported in Brachytherapy. After 24 months, the scores had decreased below baseline and were not significantly different from those with a baseline IPSS less than 15. The mean IPSS had decreased from baseline by 10.7 points in the IPSS 15 or higher group.

In addition, 2 patients (12.5%) in the IPSS 15 or higher group experienced a new grade 2 genitourinary toxicity requiring an alpha blocker compared with 21 patients (26.5%) in the IPSS less than 15 group. No patient required emergency use of a Foley catheter within 30 days of treatment, according to the investigators.


Morgan TM, Rossi PJ, Cutrell PK, et al. High-dose-rate prostate brachytherapy appears safe in patients with high baseline International Prostate Symptom Scores. Brachytherapy. 2019;  doi: 10.1016/j.brachy.2019.06.001