Advanced dose calculations and imaging in prostate brachytherapy treatment planning

Brachytherapy using low dose rate (LDR) permanent seed implant or high dose rate (HDR) temporary implant is a well established treatment for prostate cancer. This study investigates the use of advanced dose calculation and imaging techniques to improve clinical prostate brachytherapy treatments. Monte Carlo (MC) simulations are used to assess the impact of source interactions and tissue composition effects that are ignored by the TG-43U1 dose calculation algorithm used in clinical practice. MC simulation results are validated using experimental phantom measurements. The development of prostate cancer may be driven by a dominant intra-prostatic lesion (DIL) but standard brachytherapy treatments prescribe the same dose level to the whole prostate. This study assesses the feasibility of multi-parametric (mp-MRI) guided focal boost treatments that escalate dose to the DIL to improve tumour control and of focal treatments that target the DIL to reduce treatment related side effects. Source interactions and tissue effects are shown to reduce the dose that is delivered to patients in LDR treatments, particularly for patients with calcifications, however the dosimetric impact is small compared to other uncertainties in LDR seed implant brachytherapy. For HDR treatments attenuation by steel catheters has only a small impact on dose distributions. Feasibility of mp-MRI guided focal boost HDR prostate brachytherapy is demonstrated in terms of tumour delineation and the ability to dose escalate the DIL without increased dose to normal tissues. The dosimetric feasibility of LDR and HDR focal therapy treatments is demonstrated. Focal therapy treatments are shown to be more sensitive to source position errors than whole gland treatments. MC simulations of focal therapy treatments show that there are no additional concerns in terms of dosimetric accuracy compared to standard whole gland treatments. Advanced dose calculation and imaging techniques can improve clinical prostate brachytherapy treatments.