Brachytherapy improves outcomes in young men (≤60 years) with prostate cancer: A SEER analysis

Ashamalla, Hani; Guirguis, Adel; McCool, Kyle; McVorran, Shauna; Mattes, Malcolm D.; Metzger, Daniel; Oromendia, Clara; Ballman, Karla V.; Mokhtar, B.; Tchelebi, Mounzer; Katsoulakis, Evangelia; Rafla, Sameer

doi:10.1016/j.brachy.2016.12.010

Cited by 7 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 47 studies included, 25 (53.2%) used registry data, 8 (17.0%) were from clinical trials, and the remainder were retrospective single-center or multicenter studies ( Table 1 ). 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 The median follow-up was 66.0 months (IQR, 41.5-91.4 months). The number of published articles conducting comparative analysis of prostate cancer outcomes between races has increased over time, with 19.1% of studies (n = 9) reported between 1960 and 2000, 21.3% of studies (n = 10) reported between 2001 and 2010, and 59.6% of studies (n = 28) reported between 2011 and 2020.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients

et al. 2023

View full text Add to dashboard Cite

ImportanceAs the field of medicine strives for equity in care, research showing the association of social determinants of health (SDOH) with poorer health care outcomes is needed to better inform quality improvement strategies.ObjectiveTo evaluate the association of SDOH with prostate cancer–specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer.Data SourcesA MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020.Study SelectionTwo authors independently selected studies conducted among patients within the United States and performed comparative outcome analysis between Black and White patients. Studies were required to report time-to-event outcomes. A total of 251 studies were identified for review.Data Extraction and SynthesisThree authors independently screened and extracted data. End point meta-analyses were performed using both fixed-effects and random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed, and 2 authors independently reviewed all steps. All conflicts were resolved by consensus.Main Outcomes and MeasuresThe primary outcome was PCSM, and the secondary outcome was OS. With the US Department of Health and Human Services Healthy People 2030 initiative, an SDOH scoring system was incorporated to evaluate the association of SDOH with the predefined end points. The covariables included in the scoring system were age, comorbidities, insurance status, income status, extent of disease, geography, standardized treatment, and equitable and harmonized insurance benefits. The scoring system was discretized into 3 categories: high (≥10 points), intermediate (5-9 points), and low (&lt;5 points).ResultsThe 47 studies identified comprised 1 019 908 patients (176 028 Black men and 843 880 White men; median age, 66.4 years [IQR, 64.8-69.0 years]). The median follow-up was 66.0 months (IQR, 41.5-91.4 months). Pooled estimates found no statistically significant difference in PCSM for Black patients compared with White patients (hazard ratio [HR], 1.08 [95% CI, 0.99-1.19]; P = .08); results were similar for OS (HR, 1.01 [95% CI, 0.95-1.07]; P = .68). There was a significant race-SDOH interaction for both PCSM (regression coefficient, −0.041 [95% CI, –0.059 to 0.023]; P &lt; .001) and OS (meta-regression coefficient, −0.017 [95% CI, –0.033 to –0.002]; P = .03). In studies with minimal accounting for SDOH (&lt;5-point score), Black patients had significantly higher PCSM compared with White patients (HR, 1.29; 95% CI, 1.17-1.41; P &lt; .001). In studies with greater accounting for SDOH variables (≥10-point score), PCSM was significantly lower among Black patients compared with White patients (HR, 0.86; 95% CI, 0.77-0.96; P = .02).Conclusions and RelevanceThe findings of this meta-analysis suggest that there is a significant interaction between race and SDOH with respect to PCSM and OS among men with prostate cancer. Incorporating SDOH variables into data collection and analyses are vital to developing strategies for achieving equity.

show abstract

Section: Resultsmentioning

confidence: 99%

Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Ashamalla et al . [ 15 ] reported on approximately 16,000 men in the surveillance, epidemiology, and end results (SEER) database, who were aged ≤ 60 years at the time of LDR brachytherapy (with or without EBRT) or EBRT alone. The 8-year overall prostate cancer-specific mortality was 1.9%, and was lower for patients treated with LDR brachytherapy compared with those treated with EBRT alone (1.1% vs. 2.8%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Low-dose-rate brachytherapy and long-term treatment outcomes in patients younger than 60 years of age

Armstrong,

Ho,

Tacey

et al. 2024

jcb

View full text Add to dashboard Cite

Purpose Low-dose-rate (LDR) brachytherapy in young men remains controversial amongst urologists due to their concerns regarding long-term biochemical control and treatment-related toxicities. The purpose of this study was to evaluate the treatment outcomes of men under 60 years of age who underwent LDR brachytherapy with iodine-125 ( 125 I) for clinically localized low- to intermediate-risk prostate cancer. Material and methods All consecutive patients with clinically localized prostate cancer treated at our institution from 2003 to 2016 with 125 I monotherapy were included in the study. Prescription dose was 145.0 Gy modified peripheral loading (MPD). All patients were assessed for biochemical progression-free survival using Phoenix definition (nadir +2 ng/ml), clinical progression-free survival, overall survival (OS), and any associated treatment toxicity. Results A total of 161 patients were included, with a median follow-up of 6.8 years (range, 3-14.54 years). Median age at implant was 57 years (range, 53-59 years). Mean prostate specific antigen (PSA) level at diagnosis was 4.43 ng/ml (SD = 2.29). Majority of men had low-risk prostate cancer (70.2%). Biochemical progression-free survival at 8 years was 94% for the entire cohort. Median PSA at 4 years was 0.169 (IQR, 0.096-0.360), with 45% of patients having a PSA greater than 0.2. OS was 96.9%, with 5 deaths reported but only one was secondary to prostate cancer. Late grade > 2 genitourinary toxicities were reported in 18 patients (11.2%). Three patients (1.9%) developed secondary cancers, all considered unrelated to their LDR brachytherapy. Conclusions With excellent long-term treatment outcomes and minimal associated toxicities, our results showed that LDR brachytherapy can be an effective treatment of choice in younger men.

show abstract

“…Age is an important factor when choosing primary treatment, since there is a tendency to recommend surgery as the first option in young patients, due to long life expectancy; although BT appears to offer at least similar results [ 27 ]. In our study, patients up to 60 years of age had better control than older patients (97.6% at 10 years vs. 89.4%), which makes the option of BT with radioactive seeds clearly recommended, allowing better preservation of erectile function [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term results with custom-linked iodine-125 seeds and real-time brachytherapy in low- and intermediate-risk prostate cancer

Guinot¹,

Casanova²,

González-Pérez³

et al. 2022

jcb

View full text Add to dashboard Cite

Purpose Brachytherapy (BT) with iodine-125 ( 125 I) seeds is effective in low- and intermediate-risk prostate carcinoma, with fewer side effects compared to other techniques, but relapses increase in long-term. In the present paper, 10-year biochemical relapse-free survival (BRFS) results are presented. Material and methods Between 2007 and 2016, 706 patients were treated with real-time technique using Bard-ProLink™ system. 145 Gy was administered to the prostate with exclusive BT and 108 Gy after 46 Gy of external radiotherapy (EBRT). Androgen deprivation therapy was applied in 19.3% of patients. Results Median follow-up was 96 months (range, 24-163 months). BRFS at 5 and 10 years was 95% and 91.1%, respectively. For 480 low-risk cases, BRFS at 5 and 10 years was 95.7% and 92.7%, and for 226 intermediate-risk cases, it was 92.7% and 88%, respectively ( p < 0.05). With combined treatment of EBRT + BT, 133 cases (59%) of intermediate-risk were treated without differences with exclusive BT. Gleason score 4 + 3 cases dropped to 72.8% at 10 years ( p < 0.001), with androgen deprivation therapy (ADT) to 90.9% and without ADT to 66.8%; it was worse if patients had exclusive BT. 10-year BRFS for T1c was 95% compared to 84% for T2 ( p < 0.001). Initial prostate specific antigen (PSA) > or < 10 showed no differences. With > 50% biopsy cores positive, it fell to 80% at 10 years ( p < 0.001). In 154 patients up to 60 years of age, 10-year BRFS was 97.6%. Urinary complications appeared in 16.9% of cases in exclusive BT vs. 26.1% in EBRT + BT. Grade 2+ urinary late complications were observed in 19.1% and grade 3+ in 5.8% of patients. Rectal toxicity was 4% (2.5% in BT alone and 10.1% in RT + BT), while G3+ was seen in 0.1%. Conclusions Real-time BT with custom-linked 125 I seeds is a very effective long-term treatment in low- and intermediate-risk prostate carcinoma. With Gleason score 4 + 3 or > 50% biopsy cores positive, we recommend combined treatment with additional ADT for 6 months.

show abstract

Brachytherapy improves outcomes in young men (≤60 years) with prostate cancer: A SEER analysis

Cited by 7 publications

References 23 publications

Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients

Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients

Low-dose-rate brachytherapy and long-term treatment outcomes in patients younger than 60 years of age

Long-term results with custom-linked iodine-125 seeds and real-time brachytherapy in low- and intermediate-risk prostate cancer

Contact Info

Product

Resources

About