Patient reported health related quality of life for men treated with low dose rate prostate brachytherapy as monotherapy with 125 iodine, 103 palladium, or 131 cesium: Results of a prospective phase II study.
PURPOSE To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. METHODS AND MATERIALS Patients with mostly favorable intermediate risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time driven activity based costing was used to compute costs. RESULTS From 2006 to 2013, 300 patients were treated with iodine 125 (I 125, n 98, prescribed dose [PD] 145 Gy) palladium 103 (Pd 103, n 102, PD 125 Gy) or cesium 131 (Cs 131, n 100, PD 115 Gy) Median age was 64.9 years. Median follow up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I 125, Pd 103, and Cs 131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I 125 and Pd 103, whereas Cs 131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd 103. However, these differences did not reach the minimal clinically important difference. Compared with I 125, the use of Pd 103 or Cs 131 resulted in cost increases of 18% and 34% respectively. CONCLUSIONS The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd 103/I 125 over Cs 131 for bowel and sexual QoL, but this did not reach clinical significance.
Brachytherapy