TY  - EJOU
AU  - Toniolo, Gilberto Chéchile 
AU  - Jornet, Nuria 
AU  - Rojas, Jady 
AU  - Tejedor, Natalia 
AU  - Carrara, Santiago 
AU  - Maccagno, Alicia 
AU  - Brufau, Teresa 

TI  - Oncological outcomes of I<sup><b>125</b></sup> low dose brachytherapy in localized prostate cancer
T2  - Canadian Journal of Urology

PY  - 2026
VL  - 33
IS  - 1
SN  - 1488-5581

AB  -  <b>Background:</b> Low-dose rate (LDR) prostate brachytherapy is a recommended treatment of localized prostate cancer in current guidelines. The study aimed to determine biochemical relapse-free survival (BRFS) in patients treated with dynamic real-time low-dose rate (LDR) brachytherapy using Iodine 125 (I<sup>125</sup>). <b>Methods:</b> We retrospectively reviewed 499 patients with localized prostate cancer treated with I<sup>125</sup> LDR real-time brachytherapy between 2003 and 2021. The mean patient age was 65 years (range: 45–84 years). Based on the National Comprehensive Cancer Network (NCCN) risk classification, 230 patients (46.1%) were categorized as low risk, 235 (47.1%) as intermediate risk, and 34 (6.8%) as high risk. Gleason scores were distributed as follows: 3+3 in 283 cases (56.7%), 3+4 in 157 cases (31.5%), 4+3 in 46 cases (9.2%), and 4+4 in 13 cases (2.6%). The mean follow-up was 70.5 months. <b>Results:</b> Tumor relapse was observed in 47 patients (9.4%) over a mean follow-up period of 6.26 years (SD 4.16). Local recurrence within the prostate occurred in 20 cases (4%). Patients with nadir PSA &lt;0.2 ng/mL at 5 years of follow-up had a significantly lower incidence of tumor recurrence (3%) compared to those with a nadir PSA &gt;0.2 ng/mL (21.9%) (<i>p</i> = 0.0001). Biochemical relapse-free (BRFS) rates at 5, 10 and 15 years were 96%, 91.5% and 88.9%, respectively. When stratified by NCCCN risk groups, 5-year BRFS was 96% in low risk, 98% in intermediate risk and 85% in high risk patients (<i>p</i> = 0.003). In multivariate analysis, only age at the time of brachytherapy (<i>p</i> = 0.009), initial PSA (<i>p</i> = 0.007) and Gleason grade (<i>p</i> = 0.007) were significantly associated with tumor recurrence. Cancer-specific survival and overall survival were 99.8% and 98.0%, respectively <b>Conclusions:</b> LDR with I<sup>125</sup> has excellent long-term oncological outcomes for patients with low and intermediate-risk prostate cancer, in particular, patients achieving a nadir PSA &lt;0.2 ng/mL at 5 years post-treatment.
KW  - prostate cancer; brachytherapy; low-dose-rate brachytherapy; Iodine<sup>125</sup>; oncological outcomes; recurrence-free survival; prostate cancer-specific survival

DO  - 10.32604/cju.2026.069182