Additional evidence of the value of brachytherapy + EBRT + ADT in high-risk patients

Earlier today we reported data from a series of patients treated by Stock et al. with brachytherapy + external beam radiation therapy (EBRT) + androgen deprivation therapy (ADT). According to a HealthDay report published in Forbes magazine, a second paper appears to endorse the findings of Stock and his colleagues.

D’Amico et al. have reported on data from 1,342 men with a PSA level > 20 ng/ml, clinical T3 or T4 disease, and/or a Gleason score of 8 to 10. All patients received brachytherapy. They then estimated the risk of prostate cancer–specific mortality after brachytherapy alone or in conjunction with androgen deprivation therapy (ADT), external-beam radiation therapy (EBRT), or both in this high-risk population. It should be clearly pointed out, however, that this study reports retrospective analysis of data from several patient series, and is not data from a randomized clinical trial.

They showed that, despite higher baseline probabilities of prostate cancer-specific mortality, after a median follow-up of 5.1 years:

  • There was a significant reduction in the risk of prostate cancer-specific mortality in men treated with brachytherapy + ADT + EBRT as compared with neither.
  • When compared with brachytherapy alone, a significant decrease in the risk of prostate cancer-specific mortality was not observed in men treated with either supplemental ADT or EBRT.
  • There was a near-significant reduction in the risk of prostate cancer-specific mortality in men treated with tri- as compared with bimodality therapy.

The authors conclude that, “Supplemental [ADT] and EBRT but not either supplement compared with brachytherapy alone was associated with a decreased risk of prostate cancer-specific mortality in men with high-risk prostate cancer.

“Despite the increasing numbers of men worldwide who choose to undergo brachytherapy alone for their high-risk prostate cancer, the evidence supporting this treatment method alone based on survival data from randomized trials is lacking,” Dr. Anthony D’Amico stated in a news release from Brigham & Women’s Hospital in Boston.

“In order to get the highest cure rate for men with high-risk prostate cancer, it appears that 5 weeks of external beam radiation and at least 4 months of hormonal therapy should be added to brachytherapy,” he added.

One Response

  1. I am receiving this treatment now. I’m in the final phase, with Zoladex for 3 years. I have read the paper mentioned, as well as others, and am convinced that it is the most, some doctors say the only, effective treatment for my initial data: PSA 28, Gleason Sum 4 + 4, clinical stage T2aN0M0. The treatments I was offered in Amsterdam are comparatively quite ineffective (EBRT or RP). I obtained the right treatment in Sweden, where I shall remain. The reasons for the Amsterdam problem are complex. I’m a retired academic whose hobby is journalism. The Amsterdam doctors were outed by me, internationally. I was later told that my work was helpful to individuals and organizations.

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