Original article A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localised prostate cancer Dan Ash a , David Bottomley a , Bashar Al-Qaisieh b , Brendan Carey a , Kath Gould a , Ann Henry a, * a Regional Cancer Treatment Centre and b Medical Physics Department, Cookridge Hospital, Leeds, UK Abstract Background and purpose: To prospectively evaluate long-term urinary, bowel and sexual function after I-125 brachytherapy for localised prostate cancer using patient administered validated Quality of Life (QoL) instruments. Materials and methods: Between March 1995 and March 2004, 673 men underwent brachytherapy and recorded urinary symptoms prospectively using the International Prostate Symptom Score (IPSS). In addition, in a subgroup of 116 patients, the Expanded Prostate Cancer Index Composite (EPIC) was used to record QoL information on urinary, bowel and sexual function before treatment and at regular time intervals for at least two years. Results: Initially, there was a sharp rise in urinary symptoms which was most marked within the first three months. Scores then resolved slowly and returned to within one or two units of pre-treatment level at one year. Subsequently, there was no significant deterioration in urinary symptoms up to nine years following brachytherapy. Few had significant bowel symptoms. Sexual function deteriorated initially and then improved but failed to return to pre-treatment levels by two years. Patients requiring neo-adjuvant hormones experienced significantly more dysfunction. Conclusions: After an initial period of mild to moderate urinary symptoms prostate brachytherapy is well tolerated with relatively little deterioration in long-term quality of life. Long-term reduction in sexual function may be seen particularly in those requiring hormones.  c 2007 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology xx (2007) xxx–xxx. Keywords: Brachytherapy; Morbidity; Prostate cancer; Quality of life Many reports are now available which confirm that radio- active iodine seed implantation for localised prostate cancer produces good outcomes in selected patients with PSA re- lapse free survivals that are equivalent to those achieved by external beam radiotherapy or surgery [2,5,6,16,23]. There are also several publications which give details of the side effects and complications which can occur following brachytherapy [4,7,8,10–12,15,17,19,20]. These reports confirm that the risk of serious long-term side effects is low. Patients with early prostate cancer who opt for active treatment are offered a range of treatment options and of- ten choose brachytherapy because of its perceived conve- nience and favourable toxicity profile. It is therefore essential that accurate and representative information on long-term treatment related toxicity and overall quality of life be available. It is well established that physician derived toxicity data underestimate the true prevalence of symp- toms in a treated population [9]. To obtain accurate informa- tion patient derived and validated Quality of Life (QoL) instruments should be used. Many previous QoL studies have been limited by either being cross-sectional, providing only a ‘snapshot’, or lacking information about symptoms that pre- date treatment [11,18]. This work is a longitudinal study that documents baseline QoL and subsequent changes in urinary, bowel and sexual function after brachytherapy for a mini- mum of two and up to nine years following treatment. Materials and methods Patient group Between March 1995 and March 2004, 1253 men under- went trans-perineal TRUS guided I-125 prostate brachyther- apy alone for localised adenocarcinoma of the prostate in our centre. A modified peripheral loading technique was used to deliver a dose of 145 Gy and has been described pre- viously [6]. Patients presenting with a prostate volume >50 ml underwent three months of neo-adjuvant hormone manipulation, using either LHRH agonists or anti-androgens Radiotherapy and Oncology xx (2007) xxx–xxx www.thegreenjournal.com 0167-8140/$ - see front matter  c 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.radonc.2007.05.020 ARTICLE IN PRESS Please cite this article in press as: Ash D et al., A prospective analysis of long-term quality of life ..., Radiother Oncol (2007), doi:10.1016/ j.radonc.2007.05.020