What question did this study set out to answer?

To evaluate the functional outcomes and toxicity of focal low-dose-rate brachytherapy in men with low–intermediate risk prostate cancer.

February 13, 2026Open Access

Functional outcomes and toxicity following focal low‐dose‐rate brachytherapy for low–intermediate risk prostate cancer

Key Points

To evaluate the functional outcomes and toxicity of focal low-dose-rate brachytherapy in men with low–intermediate risk prostate cancer.
Participants were treated with focal low-dose-rate brachytherapy.
Follow-up assessments were conducted at 6 weeks and every 3 months thereafter.
Outcomes were measured using validated patient-reported outcome measures (PROMs).
Adverse events were graded according to existing medical criteria.
73.3% of participants had over 12 months of follow-up with a median follow-up of 33 months.
A significant increase in IPSS was observed at 6 weeks but returned to baseline at 12 months.
Erectile dysfunction scores showed significant declines in some patients, suggesting varying impact on sexual health.
No Grade ≥3 adverse events were reported.

Abstract

Abstract Objectives We aim to prospectively evaluate functional outcomes and toxicity following focal low‐dose‐rate (LDR) brachytherapy for low–intermediate risk prostate cancer (PCa). Patients and Methods LIBERATE is a clinical registry of men treated with focal LDR brachytherapy for low–intermediate risk PCa since September 2019. Follow‐up occurred at 6 weeks and every 3 months thereafter. Outcomes were assessed using validated patient‐reported outcome measures (PROMs): IPSS, Expanded PCa Index Composite (EPIC) Bowel Assessment, and International Index of Erectile Function (IIEF‐5). Adverse events (AEs) were clinically graded per Common Terminology Criteria for Adverse Events v5.0. Minimal important differences (MIDs) were defined as ±3.1 for IPSS, ±5 for EPIC bowel domain, and ±4 for IIEF‐5. Results Of 120 patients enrolled, 88/120 (73.3%) had ≥12 months follow‐up, and 79/88 (89.7%) completed PROMs with a median (IQR) follow‐up of 33 (26–41) months. At 6 weeks, a transient, statistically and clinically significant increase in IPSS was observed, which returned to baseline by 12 months (median IPSS: 6 at baseline, 12 at 6 weeks, 6 at 12 months). EPIC bowel scores showed no significant changes, with 72 (91.1%) patients having rectal spacer. Among 66 sexually active men, 40 (60.6%) had no or mild erectile dysfunction (ED) at baseline, with a median IIEF‐5 score of 22.5, decreasing to 22 at 6 weeks and plateauing at 21 at 6 months, none meeting MID criteria. For the 26 patients with mild to severe ED at baseline, the median IIEF‐5 score declined from 10 at baseline to 5 at 6 months, with partial recovery followed by a drop to 5.5 at 2.5 and 3 years. Declines at 6 months and beyond 2 years were both statistically and clinically significant. No Grade ≥3 AEs were reported. Conclusion Focal LDR brachytherapy is associated with favorable functional outcomes and minimal toxicity. Further studies are required to evaluate long‐term results.

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