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Background <p>High-dose-rate brachytherapy (HDR-BT) is a potential treatment for localized prostate cancer. However, high-quality evidence or literature on HDR-BT in older patients is limited. Therefore, we aimed to evaluate HDR-BT treatment outcomes by comparing results between older and younger patients.</p> Methods <p>We included 973 patients with primary prostate cancer who were treated with radiation therapy (external beam radiotherapy + HDR-BT) at our institution between November 1997 and December 2021. Propensity score matching was used. The biochemical freedom from failure (bFFF), prostate cancer-specific survival (PCSS), and adverse events were compared between the two groups. The groups comprised 196 matched patients aged ≥ 75 years and 196 patients aged &lt; 75 years. Multivariate analysis was conducted for bFFF.</p> Results <p>The median follow-up period after matching was 79.5 and 107.5 months for patients aged ≥ 75 and &lt; 75 years, respectively. Matched 7-year bFFF was 82.9 and 83.1% in those aged ≥ 75 and &lt; 75 years, respectively. However, 7-year PCSS was 100% and 99.3%, respectively, with no significant differences (<i>p</i> = 0.690 and 0.641, respectively). Age was not associated with bFFF in the multivariate analysis (Hazard ratio = 0.976, 95% Confidence interval: 0.674–1.414, <i>p</i> = 0.898). Conversely, low-grade T classification and, Gleason score, low initial prostate-specific antigen levels, hormone therapy, and higher doses (Biologically Effective Dose [BED] ≥ 243.0&#xa0;Gy) were significantly associated with higher bFFF. The matched 7-year cumulative incidence rate of grade ≥ 2 genitourinary adverse events was 13.5 and 20.4% for those aged ≥ 75 years and &lt; 75 years, respectively. The gastrointestinal toxicity rate was 5.3 and 4.4%, respectively, with no significant differences observed (<i>p</i> = 0.754 and 0.675, respectively).</p> Conclusions <p>Compared with the younger group (&lt; 75 years), HDR-BT for the older group (≥ 75 years) was not associated with adverse events. Moreover, high BED irradiation resulted in better bFFF.</p>

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Retrospective analysis of high-dose-rate brachytherapy for patients with prostate cancer aged ≥ 75 years

  • 期刊论文

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  • 发表日期：

    2026年1月7日

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  • Keiji Matsuda,
  • Takeshi Ogata,
  • Nobuhiko Kamitani,
  • Kenta Watanabe,
  • Ryoji Tokiya,
  • Takafumi Hayashi,
  • Yoshiyuki Miyaji,
  • Kazumasa Komura,
  • Tsutomu Tamada,
  • Kuniaki Katsui

摘要

Background

High-dose-rate brachytherapy (HDR-BT) is a potential treatment for localized prostate cancer. However, high-quality evidence or literature on HDR-BT in older patients is limited. Therefore, we aimed to evaluate HDR-BT treatment outcomes by comparing results between older and younger patients.

Methods

We included 973 patients with primary prostate cancer who were treated with radiation therapy (external beam radiotherapy + HDR-BT) at our institution between November 1997 and December 2021. Propensity score matching was used. The biochemical freedom from failure (bFFF), prostate cancer-specific survival (PCSS), and adverse events were compared between the two groups. The groups comprised 196 matched patients aged ≥ 75 years and 196 patients aged < 75 years. Multivariate analysis was conducted for bFFF.

Results

The median follow-up period after matching was 79.5 and 107.5 months for patients aged ≥ 75 and < 75 years, respectively. Matched 7-year bFFF was 82.9 and 83.1% in those aged ≥ 75 and < 75 years, respectively. However, 7-year PCSS was 100% and 99.3%, respectively, with no significant differences (p = 0.690 and 0.641, respectively). Age was not associated with bFFF in the multivariate analysis (Hazard ratio = 0.976, 95% Confidence interval: 0.674–1.414, p = 0.898). Conversely, low-grade T classification and, Gleason score, low initial prostate-specific antigen levels, hormone therapy, and higher doses (Biologically Effective Dose [BED] ≥ 243.0 Gy) were significantly associated with higher bFFF. The matched 7-year cumulative incidence rate of grade ≥ 2 genitourinary adverse events was 13.5 and 20.4% for those aged ≥ 75 years and < 75 years, respectively. The gastrointestinal toxicity rate was 5.3 and 4.4%, respectively, with no significant differences observed (p = 0.754 and 0.675, respectively).

Conclusions

Compared with the younger group (< 75 years), HDR-BT for the older group (≥ 75 years) was not associated with adverse events. Moreover, high BED irradiation resulted in better bFFF.