gms | German Medical Science

Introduction: This study evaluated morbidity after TPSI according to a defined quality management.

Patients/Methods: 334 patients (median age: 65.9 years) were treated with TPSI (125-I- Strands 0.552-0.737 mCi) because of low risk prostate cancer (cT1-2 Gleason Score <7 iPSA < 10 ng/ml) according to the recommendations of ABS, ESTRO and EORTC. Planning procedures were performed as: Online-Planning (prescription dose 145 Gy, D90 >180 Gy, V100 >99%, minimal dose at the surface of the prostate >140 Gy, D1 and D30 urethra <230 Gy and <215 Gy respectively, D10 anterior rectal wall £145 Gy, dosimetry software: PSID 3.5. In order to minimize toxicitiy each patient got alpha blockers, beginning 10 days before the procedure. Toxicity was evaluated using the modified RTOG GU toxicity scale, EORTC QLQ-C30-questionaire and IPSS (before TPSI and 1, 3, 6, 12 months after treatment).

Results: The median follow up was 28.5 (2,1-76,8) months. According to modified RTOG GU toxicity scale toxicity was categorized grade I (irritation and/or obstruction): 92.8%, grade II (transurethral catheter >7 days): 3.9%, grade III (suprapubic fistula >7days): 3,0% and grade IV: 0.4%. A grade V-toxicity did not occurred. Grade II and III toxicities occurred during 48 h after TPSI. 3 months after TPSI no incontinence was noted. 150/217 (69.1%) prior to TPSI potent patients remained potent. Erectile dysfunction was successfully treated in >80% with modern erectile drugs. 12 months after TPSI chronic rectal toxicity did not occurred and the IPSS results turned back to baseline.

Conclusions: Morbidity occurred in each patient, but in >90% of patients as grade I toxicity. Preservation of potency could be reached in 70% of patients. Incontinence and chronic rectal toxicity were not found. Therefore, TPSI in patients with “low risk” prostate cancer with defined quality assurance resulted in adequate morbidity comparable with reports in the current literature.