Combined brachytherapy, EBRT, and ADT for high-risk disease


Eight-year outcome data are now available for patients with Gleason score 8-10 prostate cancer treated with brachytherapy, external beam radiotherapy (EBRT), and androgen deprivation therapy (ADT).

Stock et al. have reported data from 181 patients localized prostate cancer and biopsy Gleason scores of 8-10 treated between 1994 and 2006 using palladium-103 seed implants, 45 Gy of EBRT and 9 months of ADT. The median follow-up was 65 months  (range, 24-150 months) and rates of biochemical progression were calculated using the Phoenix definition (nadir + 2 ng/ml).

Outcomes in this series of patients are as follows:

  • The 8-year actuarial rate of freedom from biochemical failure was 73 percent.
  • Freedom from distant metastases was 80 percent.
  • Prostate-cancer specific survival was 87 percent.
  • Overall survival was 79 percent.
  • Pretreatment PSA levels significantly affected the rate of freedom from biochemical failure, with 8-year rates of 72, 82 and 58 percent for patients with PSA level of < 10, 10-20, and > 20 ng/ml, respectively.
  • Pretreatment PSA levels had no significant effect on rates of distant metastases.
  • The Gleason score was the only factor to significantly affect rates of distant metastases.
  • The 8-year rates pf freedom from biochemical failure were 84, 55, and 30 percent for Gleason scores of 8, 9 and 10, respectively.
  • The corresponding rates of freedom from distant metastases and prostate-cancer specific survival were 86, 76, and 30 percent and 92, 80, and 62.5 percent, respectively.

The authors conclude that 8-year outcomes after this combination regimen show favorable biochemical and distant control, as well disease-specific survival rates for patients with Gleason scores of 8-10.

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