Abstract
Introduction: Low dose-rate brachytherapy is an accepted treatment for early prostate cancer in the UK. This thesis reports studies of clinical outcome from this treatment in a UK centre. Patients and Methods: Prospective observational study in three areas of outcome for patients undergoing low dose-rate (LDR) seed brachytherapy implants: i. Quality of life questionnaires were used to prospectively assess toxicity of 3 LDR brachytherapy treatments: monotherapy+/- androgen deprivation+/-external beam radiotherapy in a longitudinal study. ii. Post-implant catheter use was correlated with preoperative variables (prostate volume, androgen deprivation, urodynamic obstruction status and IPSS score) and treatment indices (Prostate D90, Urethral D10, D25, and D50). iii. Bicalutamide and goserelin for pre-brachytherapy prostate volume reduction. Results: General health related quality of life was 'a little' to 'moderately' decreased 6weeks after brachytherapy, but unchanged by clinically significant amounts >9 months after any brachytherapy treatment. Permanent problematic urinary incontinence (<4%) and significant bother from use of incontinence aids (<3%) were rare after any brachytherapy subtype. Urinary problems, principally frequency and urgent micturition worsened after brachytherapy with peak 'very much' worsened symptoms at 6-weeks post treatment and improvements to 'a little' worse than baseline at 1-2 years. Sexual function declined significantly in potent men with partners who underwent brachytherapy. By 2 years post brachytherapy, almost half of men who were potent before brachytherapy as monotherapy started using phosphodiesterase inhibitors (e. g. Viagra). Despite this medication, at least 47% reported moderate-severe erectile dysfunction. Postoperative need for catheterisation was predicted by elevated prostate volume (>35cc), raised IPSS score (>7 vs. <7), and urodynamic obstruction (vs. equivocal or unobstructed patients). Bicalutamide produced smaller reductions in prostate volume than Goserelin (-8 vs. -26% reduction in volume). Conclusions: Clinically significant changes in HRQOL were present at >12m but they were of small magnitude except for sexual side effects which continued to be common and marked. Use of an IPSS score, prostate volume and urodynamic assessment may improve selection of patients for brachytherapy. Bicalutamide is superior to goserelin for prostate cytoreduction prior to brachytherapy.