Impact of age on the Quadrella index assessing oncological and functional results after prostate brachytherapy: A 6-year analysis

Guillaume Tremblay; Truong An Nguyen; Julien Marolleau; Jean-Pierre Malhaire; Alexandre Fourcade; Nicolas Boussion; Gaelle Goasduff; Emmanuelle Martin; Gurvan Dissaux; Olivier Pradier; G Fournier; U Schick; Antoine Valeri

doi:10.5114/jcb.2023.127049

Impact of age on the Quadrella index assessing oncological and functional results after prostate brachytherapy: A 6-year analysis

J Contemp Brachytherapy. 2023 Apr;15(2):89-95. doi: 10.5114/jcb.2023.127049. Epub 2023 Apr 28.

Authors

Guillaume Tremblay¹, Truong An Nguyen^{1

2

3}, Julien Marolleau¹, Jean-Pierre Malhaire⁴, Alexandre Fourcade¹, Nicolas Boussion^{3

4}, Gaelle Goasduff⁴, Emmanuelle Martin⁴, Gurvan Dissaux^{2

3

4}, Olivier Pradier^{2

3

4}, G Fournier^{1

2

3

5}, U Schick^{2

3

4}, Antoine Valeri^{1

2

3

5}

Affiliations

¹ Urology Department, CHU, Brest, France.
² Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France.
³ LaTIM, INSERM, UMR 1101, Université de Bretagne Occidentale, Brest, France.
⁴ Radiation Oncology Department, CHU, Brest, France.
⁵ CeRePP, Paris, France.

Abstract

Purpose: As the oncological results of prostate brachytherapy (BT) are excellent for low-risk (LR) or favorable intermediate-risk (FIR) prostate cancer (PCa), evaluating the side effects has become a major issue, especially for young men. The objective of the study was to compare the oncologic and functional results of BT using Quadrella index for patients aged 60 or less compared with older patients.

Material and methods: From June, 2007 to June, 2017, 222 patients, including 70 ≤ 60 years old and 152 > 60 years old, underwent BT for LR-FIR PCa, with good erectile function at baseline according to International Index of Erectile Function-5 (IIEF-5) > 16. Quadrella index was achieved under the following circumstances: 1) Absence of biological recurrence (Phoenix criteria); 2) Absence of erectile dysfunction (ED) (IIEF-5 > 16); 3) No urinary toxicity (international prostate score symptom) IPSS < 15 or IPSS > 15, and ΔIPSS < 5; 4) No rectal toxicity (RT) (Radiation Therapy Oncology Group, RTOG = 0). Patients were treated on demand with phosphodiesterase inhibitors (PDE5i) post-operatively.

Results: The Quadrella index was satisfied for about 40-80% of patients ≤ 60 years vs. 33-46% for older patients during 6-year follow-up (significant difference from the second year). At year 5, 100% of evaluable patients aged ≤ 60 and 91.8% > 60 (p = 0.29) reached Phoenix criteria. The criterion of ED (IIEF-5 < 16) largely explained the validity rate of Quadrella alone. There was no ED for 67.2-81.4% of patients ≤ 60 years compared with 40.0-56.1% for patients > 60 (significant difference since year 4 in favor of young men). After two years of follow-up, more than 90% of patients in both the groups showed neither urinary nor rectal toxicities.

Conclusions: For young men displaying LR-FIR PCa, BT appears to be a first-class therapeutic option, as the oncological results were at least equivalent to those of older patients with good long-term tolerance.

Keywords: IIEF-5; IPSS; brachytherapy; prostate cancer; radiation therapy.