Prostate‐specific antigen relapse‐free survival and side‐effects in 734 patients with up to 10 years of follow‐up with localized prostate cancer treated by permanent ¹²⁵iodine implants

Abstract

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To report our analysis of the oncological outcome, side‐effects and complications after 125I‐brachytherapy, based on 10 years of experience, as low dose‐rate (LDR) prostate brachytherapy is an accepted, effective and safe therapy for localized prostate cancer. PATIENTS AND METHODS Between April 1999 and December 2006, 734 consecutive patients were treated with clinically localized prostate cancer with a follow‐up of ≥30 months. No patients received external beam radiotherapy and 43% received hormonal therapy before brachytherapy; this therapy was given for 3–4 months. All patients had LDR prostate brachytherapy administered by one radiation oncologist. Biochemical failure was defined according to the ‘Phoenix consensus’. RESULTS The median follow‐up for the 734 patients was 55 months; 26 had a clinical relapse and 11 died from prostate cancer; 20 patients died from other illnesses. The 10‐year actuarial biochemical control was 92%, 84% and 65%, respectively (P < 0.001) for the low‐, intermediate‐ and high‐risk groups. Multivariate Cox regression analyses identified Gleason score and prostate‐specific antigen (PSA) level as independent prognostic factors for biochemical failure. The actuarial biochemical control with Gleason score was 88%, 76% and 67% for patients with a Gleason score of ≤6, 7 and >7, respectively (P < 0.001). The biochemical control was 90%, 80% and 42% for patients with a PSA level of ≤10, 10.1–20 and >20 ng/mL, respectively (P < 0.001). No patients reported incontinence after treatment. There was acute urinary retention in 22 (2.9%) patients. Logistic regression showed that the most significant factors correlating with the probability of catheterization were the pretreatment prostate volume and hormonal therapy. CONCLUSIONS The excellent long‐term results and low morbidity, and the many advantages of prostate brachytherapy over other treatments, show that brachytherapy is an effective treatment for clinically organ‐confined prostate cancer.

Permanent seed brachytherapy for clinically localized prostate cancer: Long-term outcomes in a 700 patient cohort

“…Relatively few single-center studies with a large and homogenous sample consisting of mostly low-risk patients have been reported (12,13). Moreover, of these large studies, few were European.…”

Biochemical outcomes for patients with intermediate risk prostate cancer treated with I-125 interstitial brachytherapy monotherapy

“…Institutional series using BT monotherapy support this finding [25,26]. Cosset EBRT plus BT as combination therapy has often been used (3, 14, [29-31]) but the additional benefit of combined EBRT over BT monotherapy remains unproven.…”

Combination of androgen deprivation therapy and radiotherapy for localized prostate cancer in the contemporary era

“…Shilkrut et al, retrospectively analyzed 958 high-risk PCa patients (PSA > 20 ng/ml; GS > 8; cT3-T4) treated with doseescalated EBRT (75)(76)(77)(78)(79)(80)(81) or combined EBRT/LDR-BRT, delivered with 103 Pd or 125 I [68]. ADT consisted of LH-RH analogue ± AA.…”

“…Almost all studies providing data on the role of combination ADT + BRT come from retrospective evaluations or retrospective secondary analysis of prospective trials with different primary endpoints (Table 4) [67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82]. Even if most of these analyses were adjusted for established PCa prognostic factors, evidence of the association between ADT and survival outcomes requires a prospective randomized trial in order to balance known and unknown prognostic between treatment arms, avoiding selection bias.…”