Brachytherapy outcomes for Gleason 7 patients by primary grade


A new article from a group in the UK suggests that there is no difference in outcomes between patients with localized disease and with Gleason scores of 4 + 3 = 7 or 3 + 4 = 7 when their PSA is ≤ 10 and they are treated with iodine-125-based, permanent seed brachytherapy.

Monroe et al. report data on the outcomes of 187 patients treated between 1995 and 2004, all of whom were diagnosed with localized prostate cancer, a Gleason score of 7 and a PSA less-than-or-equals, slant 10 ng/ml. These patients were a subgroup of a total of 1,298 men treated with permanent iodine-125 prostate brachytherapy. The objective of this study was to assess whether Gleason score alone — i.e., 3 + 4 = 7 or 4 + 3 = 7 — had significant impact on patient outcome.

Results of this analysis showed the following:

  • Median follow-up was 5.0 years (range, 2.0–10.1 years).
  • 1/187 patients (0.5 percent) died of prostate cancer.
  • At 10 years, the projected, overall, recurrence-free survival level was 82.4 percent based on the ASTRO consensus criteria and 78 percent based on the Phoenix criteria.
  • For the patients with a Gleason score of 3 + 4 = 7, at 5 years:
    • The recurrence-free survival was 86.7 percent based on the ASTRO consensus criteria.
    • The recurrence-free survival was 87.9 percent based on the Phoenix criteria.
  • For the patients with a Gleason score of 4 + 3 = 7, at 5 years:
    • The recurrence-free survival was 85.2 percent based on the ASTRO consensus criteria.
    • The recurrence-free survival was 96.6 percent based on the Phoenix criteria.
  • There was no statistically significant difference in the outcomes between the two groups of patients.
  • Patients with a D90 ≥ 140 Gy (who comprised half of the group) had a recurrence-free survival level of 92.6 percent, compared with only 77.0 percent for the patients with a D90 < 140 Gy.

Munro et al. conclude that iodine-125-based brachytherapy, used as monotherapy, achieves good, medium-term, biochemical control in all patients with localized disease who have Gleason score of 7 and a PSA level ≤ 10 ng/ml. They also note a trend toward better outcomes in patients with a D90 > 140 Gy.

The outcomes of the entire series of 1,298 brachytherapy patients treated over the 10-year period was also published by Munro et al., in January 2010.

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