Restricted accessResearch articleFirst published online 2014-09
Long-term outcome of High-risk Prostate Cancer Treated with Brachytherapy Combined with External-beam Radiation Therapy and Androgen Deprivation Therapy
To evaluate long-term outcome and biochemical progressionfree survival (bPFS) in high-risk prostate cancer patients treated with brachytherapy combined with external-beam radiation therapy (EBRT) and androgen deprivation therapy (ADT).
Methods and Study Design
We retrospectively analyzed 97 high-risk prostate cancer patients treated with brachytherapy combined with EBRT and ADT. During follow-up, the post-operation prostate-specific antigen (PSA) level was monitored regularly and biochemical relapse, progression to castration-resistant prostate cancer or metastases, and causes of death were documented. We evaluated bPFS, cause-specific survival (CSS) and overall survival (OS).
Results
The bPFS, CSS and OS of the patients were 81.4%, 88.7% and 81.4%, respectively. The bPFS of the subcategories of patients stratified based on the presence or absence of a Gleason pattern 5 were 55.6% and 87.7%, respectively.
Conclusion
Brachytherapy combined with EBRT and ADT can effectively control PSA level and delay biochemical relapse in localized high-risk prostate cancer. However, patients presenting with a Gleason pattern 5 should be managed with further treatment intensification.
SylvesterJ.E., GrimmP.D., BlaskoJ.C., MillarJ., OrioPF3rd, SkoglundS., GalbreathR.W., MerrickG.: 15-Year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys, 67: 57–64, 2007.
3.
TairaA.V., MerrickG.S., ButlerW.M., GalbreathR.W., LiefJ., AdamovichE., WallnerK.E.: Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys, 79: 1336–1342, 2011.
4.
CritzF., LevinsonK.: 10-Year disease-free survival rates after simultaneous irradiation for prostate cancer with a focus on calculation methodology. J Urol, 172: 2232–2238, 2004.
5.
PottersL., MorgensternC., CalugaruE., FearnP., JassalA., PresserJ., MullenE.: 12-Year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol, 173: 1562–1566, 2005.
6.
DattoliM., WallnerK., TrueL., CashJ., SoraceR.: Long-term outcomes after treatment with brachytherapy and supplemental conformal radiation for prostate cancer patients having intermediate and high-risk features. Cancer, 110: 551–555, 2007.
7.
StockR.G., CesarettiJ.A., HallS.J., StoneN.N.: Outcomes for patients with high-grade prostate cancer treated with a combination of brachytherapy, external beam radiotherapy and hormonal therapy. BJU Int, 104: 1631–1636, 2009.
8.
CarpenterT.J., ForsytheK., KaoJ., StoneN.N., StockR.G.: Outcomes for patients with extraprostatic prostate cancer treated with trimodality therapy, including brachytherapy, external beam radiotherapy, and hormone therapy. Brachytherapy, 10: 261–268, 2011.
9.
GuarneriA., BotticellaA., FilippiA.R., MunozF., BeltramoG., CasettaG., GiglioliF.R., TizzaniA., RagonaR., RicardiU.: 125I brachytherapy for localized prostate cancer: a single institution experience. Tumori, 99: 83–87, 2013.
10.
NandaA., ChenM.H., RenshawA.A., D'AmicoA.V.: Gleason pattern 5 prostate cancer: further stratification of patients with high-risk disease and implications for future randomized trials. Int J Radiat Oncol Biol Phys, 74: 1419–1423, 2009.
11.
SabolchA., FengF.Y., Daignault-NewtonS., HalversonS., BlasK., PhelpsL., OlsonK.B., SandlerH.M., HamstraD.A.: Gleason pattern 5 is the greatest risk factor for clinical failure and death from prostate cancer after dose-escalated radiation therapy and hormonal ablation. Int J Radiat Oncol Biol Phys, 81: 351–360, 2011.
12.
StenmarkM.H., BlasK., HalversonS., SandlerH.M., FengF.Y., HamstraD.A.: Continued benefit to androgen deprivation therapy for prostate cancer patients treated with doseescalated radiation therapy across multiple definitions of high-risk disease. Int J Radiat Oncol Biol Phys, 81: 335–344, 2011.
13.
NagS., BeyerD., FriedlandJ., GrimmP., NathR.: American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys, 44: 789–799, 1999.
14.
MerrickG.S., ButlerW.M.: Modified uniform seed loading for prostate brachytherapy: rationale, design and evaluation. Tech Urol, 6: 78–84, 2000.
15.
MerrickG.S., ButlerW.M., DorseyA.T., LiefJ.H., BensonM.L.: Seed fixity in the prostate/periprostatic region following prostate brachytherapy. Int J Radiat Oncol Biol Phys, 46: 215–220, 2000.
16.
YuY., AndersonL.L., LiZ., MellenbergD.E., NathR., SchellM.C., WatermanF.M., WuA., BlaskoJ.C.: Permanent prostate seed implant brachytherapy: report of the American Association of Physicists in Medicine Task Group No 64. Med Phys, 26: 2054–2076, 1999.
17.
SalembierC., LavagniniP., NickersP., MangiliP., RijndersA., PoloA., VenselaarJ., HoskinP.; GEC ESTRO PROBATE Group: Tumour and target volumes in permanent prostate brachytherapy: a supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy. Radiother Oncol, 83: 3–10, 2007.
18.
KubanD.A., LevyL.B., PottersL., BeyerD.C., BlaskoJ.C., MoranB.J., CiezkiJ.P., ZietmanA.L., ZelefskyM.J., PisanskyT.M., ElshaikhM., HorwitzE.M.: Comparison of biochemical failure definitions for permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys, 65: 1487–1493, 2006.
19.
StockR.G., CahlonO., CesarettiJ.A., KollmeierM.A., StoneN.N.: Combined modality treatment in the management of high-risk prostate cancer. Int J Radiat Oncol Biol Phys, 59: 1352–1359, 2004.
20.
BastianP.J., GonzalgoM.L., AronsonW.J., TerrisM.K., KaneC.J., AmlingC.L., PrestiJCJr, MangoldL.A., HumphreysE., EpsteinJ.I., PartinA.W., FreedlandS.J.: Clinical and pathologic outcome after prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10. Cancer, 107: 1265–1272, 2006.
21.
BoorjianS.A., KarnesR.J., RangelL.J., BergstralhE.J., FrankI., BluteM.L.: Impact of prostate specific antigen testing on the clinical and pathological outcomes after radical prostatectomy for Gleason 8–10 cancers. BJU Int, 101: 299–304, 2008.
22.
YossepowitchO., EggenerS.E., BiancoFJJr, CarverB.S., SerioA., ScardinoP.T., EasthamJ.A.: Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods. J Urol, 178: 493–499, 2007.
23.
RoehlK.A., HanM., RamosC.G., AntenorJ.A., CatalonaW.J.: Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol, 172: 910–914, 2004.
24.
KubanD.A., TuckerS.L., DongL., StarkschallG., HuangE.H., CheungM.R., LeeA.K., PollackA.: Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys, 70: 67–74, 2008.
25.
ZelefskyM.J., FuksZ., HuntM., LeeH.J., LombardiD., LingC.C., ReuterV.E., VenkatramanE.S., LeibelS.A.: High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol, 166: 876–881, 2001.
26.
BollaM., ColletteL., BlankL., WardeP., DuboisJ.B., MirimanoffR.O., StormeG., BernierJ., KutenA., SternbergC., MattelaerJ., Lopez TorecillaJ., PfefferJ.R., Lino CutajarC., ZurloA., PierartM.: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomized controlled trial. Lancet, 360: 103–106, 2002.
27.
HanksG.E., PajakT.F., PorterA., GrignonD., BreretonH., VenkatesanV., HorwitzE.M., LawtonC., RosenthalS.A., SandlerH.M., ShipleyW.U.; Radiation Therapy Oncology Group: Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group protocol 92–02. J Clin Oncol, 21: 3972–3978, 2003.
28.
BittnerN., MerrickG.S., ButlerW.M., GalbreathR.W., LiefJ., AdamovichE., WallnerK.E.: Long-term outcome for very high-risk prostate cancer treated primarily with a triple modality approach to include permanent interstitial brachytherapy. Brachytherapy, 11: 250–255, 2012.
29.
GuarneriA., Botticella1A., FilippiA.R., Munoz1F., BeltramoG., CasettaG., GiglioliF.R., TizzaniA., RagonaR., RicardiU.: 125I brachytherapy for localized prostate cancer: a single institution experience. Tumori, 99: 83–87, 2013.
