Biochemical outcome after high‐dose‐rate intensity modulated brachytherapy with external beam radiotherapy: 12 years of experience

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Biochemical control from series in which radical prostatectomy is performed for patients with unfavorable prostate cancer and/or low dose external beam radiation therapy are given remains suboptimal. The treatment regimen of HDR brachytherapy and external beam radiotherapy is a safe and very effective treatment for patients with high risk localized prostate cancer with excellent biochemical control and low toxicity. OBJECTIVE To investigate the long‐term oncological outcome, during the PSA era, of patients with prostate cancer who were treated using high‐dose‐rate (HDR) brachy therapy (BT) combined with external beam radiation therapy (EBRT). PATIENTS AND METHODS From June 1998 to April 2007, 313 patients with localized prostate cancer were treated with 46 Gy of EBRT to the pelvis with a HDR‐BT boost. The mean (median) follow‐up was 71 (68) months. Toxicity was reported according to the Common Toxicity Criteria for Adverse Event, V.4. RESULTS The 10‐year actuarial biochemical control was 100% for patients with no high‐risk criteria, 88% for patients with two intermediate‐risk criteria, 91% with one high‐risk criterion and 79% for patients with two to three high‐risk criteria (P= 0.004). The 10‐year cancer‐specific survival was 97% (standard deviation ±1%). The multivariate Cox regression analyses identified, Gleason score and T stage as independent prognostic factors for biochemical failure. Gleason score was the only factor to significantly affect distant metastases. Grade ≥3 late toxicity was not detected. CONCLUSION The 10‐year results confirm the feasibility and effectiveness of EBRT with conformal HDR‐BT boost for patients with localised prostate cancer.

Long-term prognostic significance of rising PSA levels following radiotherapy for localized prostate cancer – focus on overall survival

“…Similar results were found in another study, reporting a bounce 15 months after treatment and biochemical failure, also defined using the Phoenix definition, after 28 months [18]. Another study reported a comparable mean time of 30 months for the occurrence of biochemical recurrence after HDR-BT + EBRT [23]. These findings indicate that increasing PSA levels within the first two years of follow-up are most probably benign PSA rises.…”

Brachytherapy and radical prostatectomy in patients with early prostate cancer

“…This result differs from the latest publications in the literature which, though not supported by randomized prospective studies, indicated BRFS results in five, ten and fifteen years similar to surgery, external radiotherapy and brachytherapy in patients with low-risk prostate cancer. 15,24 It should be noted, however, that studies show that for implanted patients, BRFS rates are widely variable according to the selection criteria adopted, ranging from 63%, at 4 years, 29 to 93%, in five years. 30 With regard to operated patients, the BRFS also varies greatly due to the pathological findings, with global BRFS rates of 81% being reported in seven years.…”

“…15 In relation to operated patients, who had a less frequent follow-up, those with at least one annual dose of PSA in the follow-up period were assessed.…”

Predictors of distant metastasis after combined HDR brachytherapy and external beam radiation for prostate cancer

“…Data with respect to predictors of distant metastasis outcomes following high-dose-rate brachytherapy are more limited [10]. Higher Gleason score has been a significant predictor of distant metastasis in most series, whereas total dose has not always been [11–13]. Determining predictors of metastatic disease following combination therapy is important, because it identifies men who could benefit from additional treatment.…”