Nuclear Medicine & Radiation Therapy

Comparison of Health Related Quality of Life and Other Clinical Parameters between 20 g and 18 g Needles for Permanent Low-Dose-Rate Implantation in Localized Prostate Cancer

Abstract

Brian J Moran and Michelle H Braccioforte

Introduction/objective: To evaluate short-term, treatment-specific endpoints observed following transperineal permanent prostate brachytherapy (TPPB) in patients with low and intermediate risk prostate cancer using a 20- gauge (g) needle technique as compared to traditional 18g needle technique. Our goal was to assess the impact of treatment on urinary, bowel, sexual function and bother as measured by Expanded Prostate Cancer Index Composite (EPIC) quality of life instrument prior to treatment and at 1,3,6 months after treatment. Additionally, acute urinary retention as measured by catheter use following prostate brachytherapy was investigated.
Methods and materials: This study was a single institution, balanced, randomized, non-blinded, dual arm interventional study. We accrued 242 low to intermediate risk patients between June 2010 and August 2012. There were 111 patients randomized to 18 g needles (Arm 1) and 131 patients randomized to 20g needles (Arm 2). A matched peripheral dose of 145 Gy was prescribed in all cases.
Patients completed EPIC questionnaires prior to TPPB and at 1, 3 and 6 months post treatment. Results: Upon analysis of EPIC scores at each time point post implantation, there was no significant difference between the two arms at any given time period specific to the urinary, bowel and sexual function and bother domains. However, 6/111 (5.4%) patients in Arm 1 and 0/131 (0%) patients in Arm 2 required Foley catheterization secondary to AUR, demonstrating a significant difference (p=0.007). Less than 2cc of perineal bleeding was seen in all patients, with no perineal pain or bruising reported. Conclusion: These data demonstrate that there was no statistically significant difference regarding quality of life parameters between Arm 1 and Arm 2. There was, however, a statistically significant outcome for AUR favoring the 20 g cohort that had 0% AUR.