10-year follow-up of brachytherapy “plus” in high-risk, localized prostate cancer


The stream of information about long-term outcomes after brachytherapy continues with an article on 10-year outcomes of high-risk patients treated with brachytherapy, adjuvant external beam radiation, and adjuvant androgen deprivation (ADT).

Fang et al. have published data on the prostate cancer-specific survival (PCSS), biochemical progression-free survival (bPFS), and overall survival (OS) of their series of patients with a Gleason score of 8 to 10 and a PSA level of ≤ 15 ng/ml. All patients were treated with permanent interstitial brachytherapy. Because they had Gleason scores of between 8 and 10, all patients also met criteria for high-risk, localized disease, but their PSA levels were relatively low.

A patient was considered to have received successful treatment (biochemically controlled disease) if his PSA remained at or below 0.4 ng/ml after achieving a nadir PSA level. In other words, the PSA could not rise to > 0.4 ng/ml after reaching its lowest level.

The data from this series of patients are as follows:

  • 174 patients initiated treatment between April 1995 and October 2005.
  • 159/174 patients (91.4 percent) received supplemental external beam radiation.
  • 113/174 (64.9 percent) received ADT.
  • Median follow-up was 6.6 years.
  • Actuarial 10-year survival data were
    • 95.2 percent PCSS for patients who did not receive ADT.
    • 92.5 percent PCSS for patients who did receive ADT.
    • 86.5 percent bPFS for patients who did not receive ADT.
    • 92.6 percent bPFS for patients who did receive ADT.
    • 75.2 percent OS for patients who did not receive ADT.
    • 66.0 percent OS for patients who did receive ADT.
  • There were no apparent predictors for PCSS.
  • bPFS and OS were most closely correlated with the age of the patient.

The authors conclude that patients with Gleason scores of 8 to 10 and a PSA level ≤ 15 ng/ml have very high levels of bPFS and PCSS after brachytherapy with supplemental external beam radiation therapy. They further conclude that, “The use of ADT did not significantly impact bPFS, CSS, or OS.”

What this paper does not do, however, is help us to determine optimal treatment for men with high-risk, localized prostate cancer. It merely adds to the information substantiating the perception that: (a) brachytherapy + external beam radiation is an appropriate form of treatment for such patients and (b) adjuvant ADT is not necessary in the vast majority of these patients. Other forms of therapy that have been regularly used in patients of this type include surgery with and without adjuvant external beam radiation therapy, external beam radiation therapy with or without adjuvant hormone therapy, and proton beam radiation therapy with or without adjuvant hormone therapy.

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