State-of-the-art: prostate LDR brachytherapy

Voulgaris, Stelios; Nobes, Jenny; Laing, Robert; Langley, Stephen

doi:10.1038/pcan.2008.9

Cited by 14 publications

(8 citation statements)

References 38 publications

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“…BCR after primary curative intended RT is relatively frequent and ranges from 10% to 60% and 7% to 35% in EBRT and brachytherapy, respectively (1,3,4). The aim in these patients is 2-fold: to determine the presence or absence of recurrent disease, and to determine its exact locations, because the disease can be local (25%-30% of cases), systemic (20%-25% of cases), or both (45%-55% of cases) (18).…”

Section: Discussionmentioning

confidence: 99%

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Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

et al. 2017

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The aim of this retrospective study was to evaluate the detection rate of Glu-NH-CO-NH-Lys-(Ahx)-[ 68 Ga(HBED-CC)] ( 68 Ga-PSMA ligand; PSMA is prostate-specific membrane antigen) PET/CT in patients with biochemical recurrent prostate cancer defined by Phoenix criteria after external-beam radiotherapy or brachytherapy as primary treatment. Methods: One hundred eighteen patients with a median prostate-specific antigen (PSA) of 6.4 ng/mL (range, 2.2-158.4 ng/mL; interquartile range, 4.2-10.2 ng/mL) were finally eligible for this retrospective analysis. Seventy-seven and 41 patients had been treated by external-beam radiotherapy or brachytherapy, respectively. Of the 118 patients, 45 were receiving androgen-deprivation therapy (ADT) within at least 6 mo before the PET/CT. The detection rates were stratified by PSA. The influence of primary Gleason score and ADT was assessed. Relationships between SUV and clinical as well as pathologic features in patients with positive findings were analyzed using univariate and multivariable linear regression models. Results: One hundred seven of 118 patients (90.7%) showed pathologic findings indicative for tumor recurrence in 68 Ga-PSMA ligand PET/CT. The detection rates were 81.8% (36/44), 95.3% (41/43), and 96.8% (30/31) for PSA of 2 to ,5, 5 to ,10, and $10 ng/mL, respectively (P 5 0.0377). 68 Ga-PSMA ligand PET/CT indicated local recurrence in 68 of 107 patients (63.5%), distant lesions in 64 of 107 patients (59.8%), and local recurrence as well as distant lesions in 25 of 107 patients (23.4%). The detection rate was significantly higher in patients with ADT (97.7%) versus without ADT (86.3%, P 5 0.0381), but independent from primary Gleason score $ 8 (92.0%) versus # 7 (90.2%, P 5 0.6346). SUV max and SUV mean were significantly associated with PSA and ADT (P 5 0.018 and 0.004 for SUV max , respectively; P 5 0.025 and 0.007 for SUV mean , respectively). Conclusion: 68 Ga-PSMA ligand PET/CT demonstrates high detection rates in patients with biochemical recurrence of prostate cancer after primary radiation therapy. The detection rate was positively associated to increasing PSA as well as concomitant ADT. 68 Ga-PSMA ligand PET/CT enables discrimination of local versus metastatic disease and thus might have a crucial impact on further clinical management. A major limitation of this study is the lack of histopathologic proof in most patients.

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Section: Discussionmentioning

confidence: 99%

“…Biochemical failure is seen in 10%-60% of patients after EBRT, depending on pretreatment risk factors and on the radiotherapy technique used (3). After brachytherapy, BCR after 5 and 10 y was reported to range from 7% to 29% and from 15% to 35%, respectively (1,4). Monitoring of PSA is a reliable and cost-effective way to detect disease relapse.…”

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confidence: 99%

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

et al. 2017

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“…A selection bias might exist in this study in the individual risk groups, as for example patients qualify for LDR-BT only with a specific maximum prostate volume. Nevertheless, favourable outcomes after LDR-BT [24, 25] and an advantage over EBRT [10, 11, 26] have been reported in the literature, including a recently published randomized study [13]. Multivariate analysis revealed the occurrence of a bounce, a low nadir value, LDR-BT vs. EBRT and HDR-BT + EBRT vs. EBRT to be independent factors regarding biochemical failure.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundThe aim of this study was to evaluate the long-term prognostic significance of rising PSA levels, particularly focussing on overall survival.MethodsTwo hundred ninety-five patients with localized prostate cancer were either treated with low-dose-rate (LDR) brachytherapy with I-125 seeds as monotherapy (n = 94; 145Gy), high-dose-rate (HDR) brachytherapy with Ir-192 as a boost to external beam RT (n = 66; 50.4Gy in 1.8Gy fractions EBRT + 18Gy in 9Gy fractions HDR) or EBRT alone (70.2Gy in 1.8Gy fractions; n = 135). “PSA bounce” was defined as an increase of at least 0.2 ng/ml followed by spontaneous return to pre-bounce level or lower, biochemical failure was defined according to the Phoenix definition.ResultsMedian follow-up after the end of radiotherapy was 108 months. A PSA bounce showed to be a significant factor for biochemical control (BC) and overall survival (OS) after ten years (BC10 of 83% with bounce vs. 34% without, p < 0.01; OS10 of 82% with bounce vs. 59% without bounce, p < 0.01). The occurrence of a bounce, a high nadir and the therapy modality (LDR-BT vs. EBRT and HDR-BT + EBRT vs. EBRT) proved to be independent factors for PSA recurrence in multivariate Cox regression analysis. A bounce was detected significantly earlier than a PSA recurrence (median 20 months vs. 32 months after RT; p < 0.01; median PSA doubling time 5.5 vs. 5.0 months, not significant). PSA doubling time was prognostically significant in case of PSA recurrence (OS10 of 72% vs. 36% with PSA doubling time ˃ 5 months vs. ≤ 5 months; p < 0.01).ConclusionsRising PSA levels within the first two years can usually be classified as a benign PSA bounce, with favourable recurrence-free and overall survival rates. PSA doubling time is an important predictor for overall survival following the diagnosis of a recurrence.

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“…Low-dose rate brachytherapy is generally accepted as equivalent in efficacy to radical prostatectomy but with a more favorable toxicity profile (14)(15)(16)(17)(18)(19)(20)(21)(22). The most common sequelae are acute irritative urinary symptoms and short-term catheterization.…”

Section: Discussionmentioning

confidence: 99%

A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy

Crook

Patil

Wallace

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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State-of-the-art: prostate LDR brachytherapy

Cited by 14 publications

References 38 publications

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

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

A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy

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State-of-the-art: prostate LDR brachytherapy

Cited by 14 publications

References 38 publications

Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

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

A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy

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Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria