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

Abstract

PURPOSE-The aim of the study was to compare prostate cancer-specific mortality (PCSM) in young men with clinically localized prostate cancer treated by either external beam radiation (EBRT) alone or brachytherapy with or without external beam radiation. and treated with radiation therapy alone were identified. Incidence of PCSM was determined for both groups and compared using competing risk models. METHODS AND MATERIALS-Utilizing RESULTS-The overall 8-year PCSM for the study population was 1.9% (95% confidence interval [CI]: 1.6-2.2). For patients treated with EBRT or brachytherapy with or without external beam, the 8-year PCSM was found to be 2.8% (CI: 2.2-3.4) and 1.2% (CI: 0.9-1.6), respectively (p < 0.001). Univariable analysis demonstrated that brachytherapy was associated with lower PCSM risk (hazard ratio = 0.40; CI: 0.30-0.54; p < 0.001). High Gleason risk category, black race, higher Tumor (T) stage, and higher grade were all associated with greater mortality risk (p < 0.01). On multivariable analysis, brachytherapy continued to be associated with a significantly lower mortality risk (hazard ratio = 0.65; CI: 0.47-0.89;p = 0.008). Subgroup analyses found that among those with Gleason score ≥8, younger patients had increased risk of PCSM (p = 0.001).CONCLUSIONS-In men ≤60 years of age with prostate cancer, radiation therapy continues to offer excellent outcomes. After adjusting for relevant variables, the use of brachytherapy was associated with reduced PCSM compared to treatment with EBRT alone.

Long‐term oncological outcomes and toxicity in 597 men aged ≤60 years at time of low‐dose‐rate brachytherapy for localised prostate cancer

“…Ashamalla et al. recently reported on ~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 significantly lower for patients who were treated with LDR brachytherapy relative to those treated with EBRT alone (1.1% vs 2.8% respectively, P < 0.001).…”

Magnetically‐actuated drug delivery device (MADDD) for minimally invasive treatment of prostate cancer: An in vivo animal pilot study

“…Comparatively, external beam radiation therapy (EBRT) has demonstrated excellent curative efficacy in the localized setting . Brachytherapy seems to be slightly inferior to ERBT with regard to prostate cancer‐specific mortality . Newer ablation therapies including cryosurgery and high‐intensity focused ultrasound (HIFU) have emerged as alternative approaches for a select group of patients .…”

Therapies for Clinically Localized Prostate Cancer

“…There probably was little to no difference in all-cause (moderate COE) and prostate-cancerspecific mortality (low COE) with AM versus EBRT plus ADT at 10-years (Table 4). 43 Deaths attributable to prostate cancer were few; 8 (1.5%) and 4 (0.7%) in the AM and EBRT plus ADT groups, respectively.…”

“…In both trials at 20 years followup, WW versus RP was associated with higher mortality among men at intermediate risk but not low-or high-risk disease. We identified six reports of two unique randomized controlled trials (RCTs) 12,[42][43][44][45][46] and nine reports of four unique non-RCTs 24,27,[47][48][49][50][51][52][53] that compared AS/AM to other therapies. Serious or critical risk of bias (ROB) precluded the inclusion of non-RCTs in the analysis.…”

“…Four reports of one eligible RCT (ProtecT) compared PSA-based AM to EBRT plus ADT or to RP and reported results for survival, metastases, quality of life, or harms. [42][43][44]46 Men with PSA-screen-detected T1c-T2 CLPC were randomized to PSA-based monitoring (which were included under the intervention category of active surveillance) AM (n=545), RP (n=553) or EBRT plus ADT (n=545). Most men had a Gleason score of 6 (77%), followed by scores of 7 (21%) and 8-10 (2%).…”