Analysis of prognostic factors in localized high-risk prostate cancer patients treated with HDR brachytherapy, hypofractionated 3D-CRT and neoadjuvant/adjuvant androgen deprivation therapy (trimodality therapy)

Abstract

Trimodality therapy consisting of high dose rate (HDR) brachytherapy combined with external beam radiation therapy (EBRT), neoadjuvant hormonal therapy (NHT) and adjuvant hormonal therapy (AHT) has been used to treat localized high-risk prostate cancer. In this study, an analysis of patients receiving the trimodality therapy was performed to identify prognostic factors of biochemical relapse-free survival (bRFS). Between May 2005 and November 2008, 123 high-risk prostate cancer patients (D'Amico classification) were treated with NHT prior to HDR brachytherapy combined with hypofractionated EBRT. Among these patients, 121 had completed AHT. The patients were assigned by time to be treated with a low-dose or high-dose arm of HDR brachytherapy with subsequent hypofractionated 3D conformal radiation therapy (3D-CRT). Multivariate analysis was used to determine prognostic factors for bRFS. With a median follow-up of 60 months, the 5-year bRFS for all patients was 84.3% (high-dose arm, 92.9%; low-dose arm, 72.4%, P = 0.047). bRFS in the pre-HDR PSA ≤ 0.1 ng/ml subgroup was significantly improved compared with that in the pre-HDR PSA > 0.1 ng/ml subgroup (88.3% vs 68.2%, P = 0.034). On multivariate analysis, dose of HDR (P = 0.045, HR = 0.25, 95% CI = 0.038–0.97) and pre-HDR PSA level (P = 0.02 HR = 3.2, 95% CI = 1.18–10.16) were significant prognostic factors predicting bRFS. In high-risk prostate cancer patients treated with the trimodality therapy, the dose of HDR and pre-HDR PSA were significant prognostic factors. The pre-HDR PSA ≤ 0.1 subgroup had significantly improved bRFS. Further studies are needed to confirm the relevance of pre-HDR PSA in trimodality therapy.

Cancer‐specific mortality of high‐risk prostate cancer after carbon‐ion radiotherapy plus long‐term androgen deprivation therapy

“…(12)(13)(14)(15)(16) In addition, high-dose or low-dose-rate brachytherapy combined with EBRT plus ADT is sometimes selected for patients with high-risk PC. (17,18) However, to the best of our knowledge, the best treatment for high-risk PC is still unknown, because no adequate comparisons of treatment modalities for high-risk PC have been performed.The National Institute of Radiological Science (NIRS) started carbon-ion RT (CIRT) for localized PC in 1995. After two phase I/II dose-escalation clinical trials, (19) three phase II studies using fixed-dose fractionations (66 and 63 gray [Gy] relative biological effectiveness [RBE] in 20 fractions and 57.6 Gy [RBE] in 16 fractions) were performed between April 2000 and March 2013.…”

“…(12)(13)(14)(15)(16) In addition, high-dose or low-dose-rate brachytherapy combined with EBRT plus ADT is sometimes selected for patients with high-risk PC. (17,18) However, to the best of our knowledge, the best treatment for high-risk PC is still unknown, because no adequate comparisons of treatment modalities for high-risk PC have been performed.…”

Two-fraction high-dose-rate brachytherapy within a single day combined with external beam radiotherapy for prostate cancer: single institution experience and outcomes

“…ADT for high-risk PCa was related to an improved bNED rate and may thereby prevent distant metastasis [ 25 ]. Ishiyama et al .…”

Perioperative Search for Circulating Tumor Cells in Patients Undergoing Prostate Brachytherapy for Clinically Nonmetastatic Prostate Cancer

“…Technical modifications for prostate brachytherapy are being developed to obtain the better treatment outcome [ 2 , 7 , 8 , 9 , 10 ]. However, approximately 5%–20% of those patients, as it now stands, show recurrence within 5 years after brachytherapy [ 1 , 2 , 5 , 11 , 12 ].…”