Purpose: The objective of this study was to evaluate the impact of intraprostatic calcifications (IC) on long-term tumor control in patients treated with permanent implant prostate brachytherapy (PIPB). Materials and Methods: Data from 609 I-125 patients treated with PIPB were retrospectively reviewed. The presence of IC was determined by reviewing postimplant CT images. Doses delivered were determined using the Monte Carlo (model-based) calculations and the TG43 approach. Biochemical relapses at 7 and 10 years were determined according to Phoenix definition. Long-term biochemical relapse-free survival (bRFS) was determined using Kaplan–Meier estimates with log rank test. Cox proportional hazard models were used for analysis of predictor factors of biochemical recurrence. Results: IC were observed for 11.1% of patients. Clinical stage, PSA, Gleason score, D'Amico risk group, and ADT use were comparable between IC and no IC groups. The 7- and 10-year bRFS for the entire cohort were 94.1% and 90.6%, respectively. The bRFS at 7 years was 90.5% (with IC) vs. 94.5% (without IC) (p = 0.198); the corresponding values at 10 years were 78.8% vs. 91.8% (p = 0.046). On Cox model, only prostatic calcifications were a significant risk factor for biochemical relapse (HR: 2.30, IC 95%: 1.05–5.00, p = 0.037; and HR: 3.94; IC 95%: 1.00–15.38; p = 0.049 for univariate and multivariate analysis, respectively). Conclusion: The presence of IC in patients treated with PIPB decreases V100 and D90 for postimplant Monte Carlo dosimetry (compared with TG43); correspondingly, IC are associated with a lower 10-y bRFS. Model-based dose calculations are critical to evaluate potential cold spots due to calcifications.

Additional Metadata
Keywords Brachytherapy, Calcification, Dosimetry, Monte Carlo, Permanent implant, Prostate cancer, Tumor control
Persistent URL dx.doi.org/10.1016/j.brachy.2019.06.007
Journal Brachytherapy
Citation
Vigneault, E. (Eric), Mbodji, K. (Khaly), Carignan, D. (Damien), Martin, A.-G. (André-Guy), Miksys, N. (Nelson), Thomson, R.M, … Beaulieu, L. (Luc). (2019). The association of intraprostatic calcifications and dosimetry parameters with biochemical control after permanent prostate implant. Brachytherapy. doi:10.1016/j.brachy.2019.06.007