Hormones + brachytherapy + EBRT: more than we need?

A paper in press in the Journal of Urology has suggested that, for patients with intermediate-risk prostate cancer who elect treatment with a combination of standard (low dose) brachytherapy and external beam radiation therapy (EBRT), the addition of hormone therapy adds little in terms of clinical benefit.

Stock et al. have reviewed data from their institution on 432 intermediate-risk patients, all of whom were treated for intermediate-risk prostate cancer between 1994 and 2006 using a combination of low-dose brachytherapy and EBRT, with or without 9 months of androgen deprivation therapy (ADT). Their data review showed that:

  • The patient’s Gleason score was 7 in 76 percent of cases.
  • PSA levels ranged from 1.4 to 20 ng/ml (median, 7.6).
  • 350/432 patients (81.0 percent) received ADT and 82 (19 percent) did not.
  • The biologically effective dose used to treat the patients ranged from 142 to 280 Gy (median, 206 Gy).
  • Patients were followed for between 23 and 155 months (median, 56 months).

The patients’ overall rate of freedom from biochemical relapse was assessed according to the Phoenix criteria (meaning that biochemical relapse was defined by a PSA level of the nadir or lowest PSA level achieved post-treatment + 2 ng/ml). Based on this assessment, the authors state that:

  • The overall rate of freedom from biochemical failure in patients who received ADT was 92 percent, and the same freedom from failure rate (92 percent) was observed in patients with did not receive ADT.
  • Similarly, the addition of ADT to combined radiation therapy had no significant impact on the rate of freedem from biochemical failure in selected subgroups of patients:
    • For patients with a Gleason score of 7, the rates were 92 and 90.5 percent, respectively.
    • For patients with PSA levels of 10 to 20 ng/ml, the rates were 92 and 100 percent, respectively.
    • For patients with clinical stage T2b-c disease, the rates were 89.5 and 97 percent, respectively.
    • For patients with more than one intermediate risk feature, the rates were 90 and  100 percent, respectively.

Stock and his colleagues state clearly that, at least in this series of patients, who received a highly biologically effective dose of radiation through the use of combination treatment, the addition of ADT did not have a significant impact on the rate of freedom from biochemical failure at 8 years.

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