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UroToday.com- An adequate radiation dose and administration of androgen-deprivation therapy (ADT) are the keys to local control in patients with prostate cancer (CaP) undergoing brachytherapy according to a report by Dr. Nelson Stone inside the Could 2007 concern with the Journal of Urology.
A total of 1,562 patients with out lymph node metastasis were treated with brachytherapy for CaP at 1 institution. Patients had been stratified into low, intermediate or high risk. Low threat males with prostate volumes >50cc had been treated with 3-5 months of ADT, intermediate threat with 6 months ADT and high risk with 9 months ADT. Radiation consisted of 160Gy 125I for low danger disease, 124Gy 103Pd for intermediate risk, and 100Gy 103Pd for high threat followed by 45Gy external beam radiotherapy. Those with a positive seminal vesicle biopsy also received seed placement inside the seminal vesicles.
With the total number of patients, 508 had a prostate biopsy at 2 years following implantation and make up the reported study cohort. Median age was 66 years and patients were categorized as low, intermediate and high danger in 43%, 24%, and 33%. A total of 237 patients received ADT as described above. In those with a positive prostate biopsy at two years, a repeat biopsy was offered yearly until it became negative or there was evidence of PSA progression.
Median follow-up was 6.7 years and a total of 643 biopsies had been performed in 508 guys. In these 508 men, a positive biopsy was documented in 39 (7.7%) and 99 (19.5%) had PSA failure. Multivariable analysis demonstrated that radiation dose and use of ADT were considerably connected with a positive biopsy. Only radiation dose was significant in low threat males, while dose and ADT had been significant in intermediate danger men and ADT and mixture radiation therapy important in high threat guys. Amongst intermediate danger guys, high dose radiation plus ADT decreased the risk of a positive biopsy from 10.8% to 2%. In males with high threat disease, high dose radiation plus ADT decreased the positive biopsy rate from 28.6% to 6.5%.
The 10-year freedom from biochemical failure was 84% for the entire cohort. If the final biopsy was negative, there was an 80% freedom from PSA failure at ten years compared to 27.3% for a positive biopsy. There were 52 males using a positive biopsy at year two and 23 of these had a subsequent negative biopsy.
Stone NN, Stock RG, White I, Unger P
J Urol 2007; 177(5):1759-64
Reviewed by UroToday.com Contributing Editor Christopher P. Evans, MD
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