12-YEAR OUTCOMES FOLLOWING PERMANENT PROSTATE BRACHYTHERAPY IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER
- 1 May 2005
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 173 (5), 1562-1566
- https://doi.org/10.1097/01.ju.0000154633.73092.8e
Abstract
Purpose: We reviewed the outcomes in men treated with permanent prostate brachytherapy (PPB). Material and Methods: A total of 1,449 consecutive patients with a mean age of 68 years treated with PPB between 1992 and 2000 and mean pretreatment prostate specific antigen (PSA) 10.1 ng/ml were included in this study. Of the patients 55% presented with Gleason 6 tumors and 28% had Gleason 7 disease. A total of 400 patients (27%) were treated with neoadjuvant hormones and 301 (20%) were treated in combination with external radiation plus PPB. Several biochemical freedom from recurrence (BFR) definitions were determined. Statistical analysis consisted of log rank testing, Kaplan-Meier estimates and Cox regression analysis. Results: Median followup was 82 months with 39 patients at risk at for 144 months. Overall and disease specific survival at 12 years was 81% and 93%, respectively. The 12-year BFR was 81%, 78%, 74% and 77% according to the American Society for Therapeutic Radiology and Oncology (ASTRO), ASTRO-Kattan, ASTRO-Last Call and Houston definitions, respectively. The 12-year ASTRO-Kattan BFR using risk stratification was 89%, 78% and 63% in patients at low, intermediate and high risk, respectively (p = 0.0001). Multivariate analysis identified the dose that 90% of the target volume received (p <0.0001), pretreatment PSA (p = 0.001), Gleason score (p = 0.002), the percent positive core biopsies (p = 0.037), clinical stage (p = 0.689), the addition of hormones (p = 0.655) and the addition of external radiation (p = 0.724) for predicting BFR-ASTRO. Five-year disease specific survival was 44% in patients with a PSA doubling time of less than 12 months vs 88% in those with a PSA doubling time of 12 months or greater (p = 0.0001). Conclusions: PPB offers acceptable 12-year BFR in patients who present with clinically localized prostate cancer. Implant dosimetry continues as an important predictor for BFR, while the addition of adjuvant therapies such as hormones and external radiation are insignificant. In patients who experience biochemical failure it appears that PSA doubling time is an important predictor of survival.Keywords
This publication has 15 references indexed in Scilit:
- Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995International Journal of Radiation Oncology*Biology*Physics, 2003
- Brachytherapy for carcinoma of the prostate: Techniques, patient selection, and clinical outcomesSeminars in Radiation Oncology, 2002
- External radiotherapy and permanent prostate brachytherapy in patients with localized prostate cancer•Brachytherapy, 2002
- 10-year biochemical (prostate-specific antigen) control of prostate cancer with 125I brachytherapyInternational Journal of Radiation Oncology*Biology*Physics, 2001
- A comprehensive review of CT-based dosimetry parameters and biochemical control in patients treated with permanent prostate brachytherapyInternational Journal of Radiation Oncology*Biology*Physics, 2001
- The definition of biochemical failure in patients treated with definitive radiotherapyInternational Journal of Radiation Oncology*Biology*Physics, 2000
- American Brachytherapy Society recommendations for clinical implementation of NIST-1999 standards for 103palladium brachytherapyInternational Journal of Radiation Oncology*Biology*Physics, 2000
- American brachytherapy society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancerInternational Journal of Radiation Oncology*Biology*Physics, 1999
- A Dose–Response Study for I-125 Prostate ImplantsInternational Journal of Radiation Oncology*Biology*Physics, 1998
- Dosimetry of interstitial brachytherapy sources: Recommendations of the AAPM Radiation Therapy Committee Task Group No. 43Medical Physics, 1995