Imaging Choice May Influence Brachytherapy Outcomes

April 2014, Vol 5, No 3

San Francisco, CA—Magnetic resonance imaging (MRI)-guided brachy­therapy led to significantly less urinary dysfunction in men being treated for localized prostate cancer compared with ultrasound-guided techniques, according to a long-term prospective cohort study reported at the 2014 Genitourinary Cancers Symposium.

Patients who received brachytherapy guided with ultrasound had significantly higher rates of urinary obstruction and incontinence and worse incontinence-associated quality of life (QOL) at 3 months compared with brachytherapy guided with MRI (P = .01 to P = .002). Incontinence and QOL remained significantly different in favor of MRI guidance at 5 years (P = .05).

“MRI-guided brachytherapy is associated with reduced short- and long-term urinary dysfunction compared to standard ultrasound-guided brachy­therapy,” concluded James A. Talcott, MD, Director, Center for Health Care Quality and Outcomes Research, Mount Sinai Beth Israel, New York, and colleagues.

“Current standard ultrasound-guided brachytherapy may produce less long-term incontinence than earlier thought, although it may grow over time.”

The findings add to those of a previous study by the same group, showing variations in short-term urinary outcomes at 2 hospitals that used different ultrasound-guided techniques.

Although widely used to treat clinically localized prostate cancer, brachytherapy can involve different techniques. The extent to which technique influences patient-reported outcomes has not been well studied.

Study Details
Dr Talcott and colleagues prospectively followed 286 patients with clinically localized prostate cancer treated by brachytherapy at 3 Boston-area hospitals. One hospital used MRI-guided target volume, which avoids the transition zone. The other 2 hospitals used conventional ultrasound-guided techniques for brachytherapy.

Patients completed health surveys before treatment and at 1 and 3 months after treatment, then annually or every other year for 5 years of follow-up. Questionnaires included the Prostate Cancer Symptoms Indexes, urinary QOL scale, SF-12 general health survey, and the Profile of Mood States.

Compared with the MRI group, patients treated with ultrasound guidance had scores on evaluations of acute urinary morbidity indicating more symptoms of obstruction or irritation (28.8 vs 20.0; P = .01), more incontinence (9.6 vs 2.2; P = .002), and worse incontinence-related QOL (10.2 vs 2.4; P = .0002). At the 5-year follow-up, the ultrasound subgroup still had significantly more incontinence (7.5 vs 3.3; P = .05) and worse QOL (5.6 vs 1.2; P = .01).

Other patient-reported outcomes, including bowel and sexual function, did not differ significantly between the groups.

As a result of the study, the investigators discovered that within the subgroup of patients treated with ultrasound guidance, patients at 1 of the 2 hospitals reported significantly more urinary symptoms. A comparison of techniques showed that patients with more urinary symptoms were treated according to a protocol that included the use of an indwelling urinary catheter.

Eliminating the catheter from the protocol led to similar urinary outcomes at the 2 hospitals during the remainder of follow-up.

“QOL outcomes vary by BT [brachytherapy] technique,” the investigators concluded. “Measuring QOL may provide useful information for patients choosing treatment and providers assessing their technique.”

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