Prostate cancer news reports: Wednesday, January 20, 2010

In today’s news reports we comment on three different articles dealing with radiotherapy in first-line treatment for localized prostate cancer:

  • Iodine-125-based brachytherapy without adjuvant hormone therapy or EBRT in younger males
  • Comparative outcomes of brachytherapy patients of 60 and younger and > 60 years of age
  • Radiation toxicities after EBRT in men who have had a prior TURP

Gómez-Iturriaga Piña et al. have reported on the effectiveness and safety of iodine-125-based brachytherapy (125I-BT) when used alone (without adjuvant hormone therapy or external beam radiotherapy) as first-line therapy for men with T1-2 prostate cancer who are ≤ 55 years of age at their institution. This is a retrospective analysis of data from 96 men treated between May 1999 and November 2005. The median age of the patients at treatment was 53 years (range, 45-55 years). All patients were followed for at least 30 months and the median follow-up was 63 months. Only 1 patient experienced a biochemical failure, and the actuarial 7-year of biochemical relapse-free survival is 98.9 percent. Grade 2 acute and late genitourinary (GU) toxicity rates were 9.8%and 10.6 percent, respectively. Grade 3 GU toxicity (urethral stricture) was observed in 3 men and was corrected with urethral dilatation or transurethral resection. Two patients (2.2 percent)  developed grade 2 gastrointestinal toxicity (proctitis). Erectile function was preserved in 85/91 men with prior good function (93.4% percent); 41/91 patients (45 percent) used phosphodiesterase-5 inhibitors. The authors conclude that,  this group of younger men “experienced excellent bNED rates with low toxicity” and that “Men in this age group should be offered low dose rate prostate BT as an option to consider.” As usual, what we don’t know is what percentage of these men might have done just fine on some type of expectant management regimen.

A second retrospective study, by Burri et al., has investigated the outcomes of men ≤ 60 years of age and > 60 years of age who were treated with low-dose brachytherapy. Between  1990 and 2005, a cohort of 1,665 men with clinically localized prostate cancer were treated with low-dose-rate brachytherapy ± hormone therapy (HT) ± external beam radiotherapy and underwent at least 2 years of follow-up. Median follow-up was 68 months (range, 24-180) for the 378 patients ≤ 60 years and 66 months (range, 24-200) for the 1,287 patients  > 60 years. The men ≤ 60 had similar 5- and 8-year rates of freedom from biochemical failure (95 and 92 percent, respectively) compared with the men > 60 (93 and 87 percent). However, the younger patients were more likely to present with low-risk disease; had lower clinical stage, Gleason score (GS), and pretreatment PSA values; were treated after 1997; did not receive any HT; and had a high effective dose of radiation. The authors conclude by stating that, “Young age should not be a deterrent when considering brachytherapy as a primary treatment option for clinically localized prostate cancer,” which is hardly an astonishing conclusion.

Devisitty et al. have reported that men treated with external beam radiation therapy (EBRT) for localized prostate cancer after a prior transurethral resection of the prostate or TURP are at increased risk for acute and severe radiation toxicities compared to men who have never had a TURP, but they also note that the overall incidence of long-term toxicity is low, and tends not to persist. Specifically, they state that the rate of acute Grade 2 or higher genitourinary toxicity was 41 percent in TURP patients, and higher in men with a history of more than one TURP (73 vs. 31 percent). The rate of Grade 3 or higher genitourinary toxicity at 4 years post-radiation was 16 percent overall, and was very significantly decreased for those patients who had  received adjuvant hormone therapy (55 vs. 5 percent without ADT). However, by the time of last follow-up, severe genitourinary toxicities tended to resolve.

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