Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high gleason grade prostate carcinoma

Abstract

BACKGROUND The authors report observed 10‐year brachytherapy results in the treatment of 152 consecutive patients with clinically organ‐confined prostate carcinoma. METHODS One hundred and fifty‐two consecutive patients with T1‐T3, low to high Gleason grade, prostate carcinoma were treated between January 1987 and June 1988 at Northwest Hospital in Seattle, Washington. Their median age was 70 years (range, 53‐92 years). Of these 152 patients, 98 (64%) received an iodine‐125 implant alone (Group 1), and the remaining 54 patients (36%), who were judged to have a higher risk of extraprostatic extension, also were treated with 45 gray (Gy) of external beam irradiation to the pelvis (Group 2). No patient underwent lymph node sampling, and none received androgen ablation therapy. Multivariate regression and the Mann‐Whitney rank sum test were used for statistical analysis. Preoperative patient data with associated success or failure outcomes at 10 years after treatment were used for training and validating a back‐propagation neural network prediction program. RESULTS The average preoperative prostate specific antigen (PSA) value, clinical stage, and Gleason grade were 11.0 ng/mL, T2, and 5, respectively. The median posttreatment follow‐up was 119 months (range, 3‐134 months). Overall survival 10 years after treatment was 65%. At last follow‐up only 3 of the 152 patients (2%) had died of prostate carcinoma. Ninety‐seven patients (64%) remained clinically and biochemically free of disease at 10 years of follow‐up and had an average PSA value of 0.18 ng/mL (range, 0.01‐0.5 ng/mL). In these patients a period of 42 months was required to reach the average PSA (0.5 ng/mL). The median to last PSA follow‐up was 95 months (range, 3‐134 months). Postoperative needle biopsies were negative in 56% of patients, positive in 15% of patients, and not available in 29% of patients. Only 6% of patients developed bone metastasis. At 10 years there was no statistically significant difference in treatment outcome between patients who received iodine‐125 alone, and those who received iodine‐125 with 45‐Gy external beam irradiation (P = 0.08). Nevertheless, in these two groups preoperative PSA, stage, and Gleason grade were significantly different (P < 0.01). In the artificial neural network analysis, pretreatment serum PSA was the most accurate predictor of disease‐free survival. CONCLUSIONS Percutaneous prostate brachytherapy is a valid and efficient option for treating patients with clinically organ‐confined, low to high Gleason grade, prostate carcinoma. Observed 10‐year follow‐up documents serum PSA levels superior to those reported in several published external beam irradiation series, and comparable to those published in a number of published radical prostatectomy series. Cancer 1998;83:989‐1001. © 1998 American Cancer Society.

COMP report: CPQR technical quality control guidelines for low‐dose‐rate permanent seed brachytherapy

“…This treatment option is offered to patients having early localized prostate cancer (Stage < T2c, Gleason score < 7, and PSA < 10). Biochemical disease‐free survival rates have now been reported for this procedure for extended follow‐up periods 14, 15, 16, 17, 18, 19, 20, 21. Similar results are also available in a Canadian context 22, 23, 24, 25…”

3-D Conformal HDR Brachytherapy as Monotherapy for Localized Prostate Cancer

“…In Germany and other European countries more and more institutions have just started to establish LDR brachytherapy as an alternative to RP and 3-D CRT [35]. Long-term results from large series in North America are now available with encouraging biochemical control rates and acceptable toxicity [10,27]. However, although improvements have been made in implantation techniques and dose-planning procedures for permanent seed implantation, there are still a number of critical issues to discuss.…”

Physikalische Grundlagen und klinische Durchführung der interstitiellen Brachytherapie der Prostata mit Jod-125

“…Das lokal begrenzte Prostatakarzinom kann durch interstitielle Brachytherapie mit Jod-125-Seeds erfolgreich therapiert werden [2,3,6,16,17,19]. Eine internationale [1] und verschiedene nationale Fachgesellschaften [8,10,11,24,26] haben Empfehlungen zur Durchführung der Monotherapie der Prostata mit Jod-125-Seeds publiziert.…”