Date Published:2013 Jun
PURPOSE: Patients with favorable-risk prostate cancer may be attracted to focal therapy aimed at the dominant intraprostatic lesion as a middle ground between the morbidity of full gland treatment and the uncertainty of observation. The various approaches involve isotopes having different energies implying different dosimetric characteristics. This work seeks to determine if choice of isotope makes a substantial difference in the fraction of prostate that may be implanted as a function of implant volume and rectal dose limit. METHODS: Representations of prostate, urethra and rectum were generated from MR scans as part of an IRB approved medical record review of patients with confirmed low risk prostate cancer. Anatomic structures were digitized on a 2.5 × 2.5 × 5.0 mm grid. Focal implants were simulated by placement of a single source. All prostate points 5 mm or further from a sensitive structure were considered as potential implant location. Dose distributions were calculated for implants of 125I, 109Pd and 192Ir. The fraction of potential implant locations that respected normal tissue constraints (rectum: 10-100% of Rx, urethra 100-200% of Rx) as a function of prescription radius was recorded. RESULTS: The fraction of the prostate implantable for a given prescription radius primarily depends on the normal tissue dose limits that are to be respected with a secondary dependence on isotope. Prescription radius less than 1 cm and rectal dose constraints greater than 50% of prescription dose allow a substantial portion of the gland to be considered for a focal implant. Detailed results are presented as a function of normal tissue constraints and prescription radius. CONCLUSION: While isotope choice does affect the implantable volume, the effect is secondary to the choice of prescription parameters. Choice of focal brachytherapy approach may be made based on consideration of duration of irradiation or clinical concerns.