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Peer-reviewedCC BY-NC-ND 4.0Advances in Radiation Oncology

Long-Term Outcomes of a Prospective Study on Magnetic Resonance Imaging-Guided Whole-Gland Salvage High-Dose-Rate Prostate Brachytherapy for Locally Recurrent Prostate Cancer

  • Hsin-Pei Hu1,2
  • Gerard Morton1,2
  • Andrew Loblaw1,2
  • Chia-Lin Tseng1,2
  • Jure Murgic3,4
  • Ananth Ravi2
  • Melanie Davidson5
  • Matt Wronski1,2
  • Moti Paudel1,2
  • Masoom Haider6,7
  • Andrea Deabreu1
  • Liying Zhang1
1 more authors
  • Hans T. Chung1,2
7 affiliations
  1. 1Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
  2. 2Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
  4. 4Croatian Catholic University School of Medicine, Zagreb, Croatia
  5. 5Department of Radiation Oncology, BC Cancer Kelowna, Kelowna, British Columbia, Canada
  6. 6Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  7. 7Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Abstract

Purpose: Whole-gland salvage high-dose-rate (HDR) prostate brachytherapy is an emerging option for radiorecurrent prostate cancer. However, long-term prospective data remain limited. This report presents the long-term results of our prospective study on the toxicities, health-related quality of life, and efficacy of whole-gland HDR prostate brachytherapy.

Methods and Materials: Patients with biopsy-confirmed, magnetic resonance (MR)-visible local recurrent prostate cancer after previous external beam radiation therapy (EBRT) were eligible. Patients underwent MR-assisted, ultrasound-based whole-gland HDR prostate brachytherapy with a prescription dose of 21 Gy to the entire prostate and 27 Gy to the MR-defined intraprostatic target volume (TV) divided over 2 implants separated by 1 to 2 weeks. Adjuvant androgen deprivation therapy was not used.

Results: Thirty patients were enrolled in the study. Median follow-up from salvage HDR was 72.0 months (10.7-121.5 months). Most patients (93%) had initial EBRT doses at conventional fractionation. The pre-HDR median prostate-specific antigen was 3.67 ng/mL (0.56-11.01 ng/mL). Seven (23.3%) were staged with prostate-specific membrane antigen positron emission tomography. Four (13%) required temporary urinary catheterization. There was only 1 (3.3%) grade 3 to 5 toxicity—a late grade 3 genitourinary toxicity. The prostate-specific antigen progression-free survival and freedom from androgen deprivation therapy rates were 73.0% and 93.0% at 3 years, and 24.8% and 69.6% at 5 years, respectively. Of the 26 patients who had a post-HDR MR imaging (median, 415 days), 9 (35%) had persistent disease. Of the 23 (77%) patients who had prostate-specific antigen relapse, 18 (78%) patients had disease at the TV confirmed by MR imaging, prostate-specific membrane antigen positron emission tomography, or targeted biopsy.

Conclusions: Whole-gland salvage HDR brachytherapy with intraprostatic boost is well tolerated. Progression after salvage treatment was associated with local failure.

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Cite

BibTeXRIS
BibTeX
@article{hu2026longterm,
  title = {{Long-Term Outcomes of a Prospective Study on Magnetic Resonance Imaging-Guided Whole-Gland Salvage High-Dose-Rate Prostate Brachytherapy for Locally Recurrent Prostate Cancer}},
  author = {Hsin-Pei Hu and Gerard Morton and Andrew Loblaw and Chia-Lin Tseng and Jure Murgic and Ananth Ravi and Melanie Davidson and Matt Wronski and Moti Paudel and Masoom Haider and Andrea Deabreu and Liying Zhang and Hans T. Chung},
  journal = {Advances in Radiation Oncology},
  year = {2026},
  month = aug,
  doi = {10.1016/j.adro.2026.102168},
  url = {https://doi.org/10.1016/j.adro.2026.102168},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Long-Term Outcomes of a Prospective Study on Magnetic Resonance Imaging-Guided Whole-Gland Salvage High-Dose-Rate Prostate Brachytherapy for Locally Recurrent Prostate Cancer
AU  - Hsin-Pei Hu
AU  - Gerard Morton
AU  - Andrew Loblaw
AU  - Chia-Lin Tseng
AU  - Jure Murgic
AU  - Ananth Ravi
AU  - Melanie Davidson
AU  - Matt Wronski
AU  - Moti Paudel
AU  - Masoom Haider
AU  - Andrea Deabreu
AU  - Liying Zhang
AU  - Hans T. Chung
PY  - 2026
DA  - 2026/08/21
JO  - Advances in Radiation Oncology
DO  - 10.1016/j.adro.2026.102168
UR  - https://doi.org/10.1016/j.adro.2026.102168
AB  - Purpose: Whole-gland salvage high-dose-rate (HDR) prostate brachytherapy is an emerging option for radiorecurrent prostate cancer. However, long-term prospective data remain limited. This report presents the long-term results of our prospective study on the toxicities, health-related quality of life, and efficacy of whole-gland HDR prostate brachytherapy.  Methods and Materials: Patients with biopsy-confirmed, magnetic resonance (MR)-visible local recurrent prostate cancer after previous external beam radiation therapy (EBRT) were eligible. Patients underwent MR-assisted, ultrasound-based whole-gland HDR prostate brachytherapy with a prescription dose of 21 Gy to the entire prostate and 27 Gy to the MR-defined intraprostatic target volume (TV) divided over 2 implants separated by 1 to 2 weeks. Adjuvant androgen deprivation therapy was not used.  Results: Thirty patients were enrolled in the study. Median follow-up from salvage HDR was 72.0 months (10.7-121.5 months). Most patients (93%) had initial EBRT doses at conventional fractionation. The pre-HDR median prostate-specific antigen was 3.67 ng/mL (0.56-11.01 ng/mL). Seven (23.3%) were staged with prostate-specific membrane antigen positron emission tomography. Four (13%) required temporary urinary catheterization. There was only 1 (3.3%) grade 3 to 5 toxicity—a late grade 3 genitourinary toxicity. The prostate-specific antigen progression-free survival and freedom from androgen deprivation therapy rates were 73.0% and 93.0% at 3 years, and 24.8% and 69.6% at 5 years, respectively. Of the 26 patients who had a post-HDR MR imaging (median, 415 days), 9 (35%) had persistent disease. Of the 23 (77%) patients who had prostate-specific antigen relapse, 18 (78%) patients had disease at the TV confirmed by MR imaging, prostate-specific membrane antigen positron emission tomography, or targeted biopsy.  Conclusions: Whole-gland salvage HDR brachytherapy with intraprostatic boost is well tolerated. Progression after salvage treatment was associated with local failure.
SN  - 2452-1094
ER  -