Long-term outcome of early stage prostate cancer treated with brachytherapy analysis after a mean follow-up of 7 years

Five-year effectiveness of low-dose-rate brachytherapy: comparisons with nomogram predictions in patients with non-metastatic prostate cancer presenting significant control of intra- and periprostatic disease

PURPOSE

To assess the effectiveness of low-dose-rate (LDR) brachytherapy in patients with localized prostate cancer and to compare the outcome with predictions from Kattan and Partin nomograms at 60 months after seed implantation.

MATERIAL AND METHODS

One thousand, one hundred and eighty-seven patients with localized prostate cancer at low-, intermediate-, or high-risk of progression received LDR brachytherapy using iodine-125 seeds with curative intent, applied as monotherapy or in combination with external beam radiation therapy (EBRT), and/or androgen deprivation therapy (ADT). At 60 months after seed implantation, data of 1,064 patients (1,058 alive + 6 who died of prostate cancer) were analyzed for biochemical progression-free survival (bPFS) based on prostate-specific antigen (PSA) levels using the Phoenix definition. Five-year bPFS probabilities were determined for various risk group classifications (d'Amico, Mt. Sinai, MSKCC/Seattle, NCCN). Outcomes were also compared to patient-individualized nomogram predictions of 5-year bPFS (Kattan 2002) and probability of organ-confined disease (Kattan 2002, Partin 2007).

RESULTS

Overall, 93.3% (993/1,064) of the patients were free of biochemical progression within 5 years, while the average 5-year bPFS probability according to the Kattan nomogram was significantly lower (85%, p < 0.001). Outcomes were significantly better than Kattan nomogram predictions in the subgroup of patients with monotherapy as well as in patients additionally treated with EBRT. Comparison of the overall outcome with nomogram predictions for organ-confined disease (Kattan nomogram: 50%; Partin nomogram: 65%) revealed a significant probability of LDR brachytherapy to destroy periprostatic tumor spread (p < 0.001) in all risk group constellations, even in high-risk patients.

CONCLUSIONS

The results indicate high effectiveness of LDR brachytherapy in all risk groups, significantly better than predicted with the Kattan nomogram in most subgroups. The significant superiority of LDR brachytherapy compared to nomogram predictions of organ-confined disease suggests that LDR brachytherapy effectively controls both intra- and periprostatic disease.

Survival Outcomes in Men Undergoing Radical Prostatectomy After Primary Radiation Treatment for Adenocarcinoma of the Prostate

PURPOSE

Salvage radical prostatectomy (SRP) is a treatment modality for patients with radio-recurrent prostate cancer but is currently underutilized. We analyzed the survival outcomes in patients receiving SRP for radio-recurrent prostate cancer. The secondary outcome was effect of lymph node dissection on survival following SRP.

MATERIALS AND METHODS

The Surveillance, Epidemiology, and End Results (SEER) 18 registry was used to identify patients that underwent radical prostatectomy between 1988 and 2010. Search identified 2628 patients with prostate cancer that underwent surgery after radiation. Following exclusion, 364 patients remained. Endpoints included overall survival (OS) and cancer-specific survival (CSS). Effect of pelvic lymph node dissection (PLND) status and number of nodes retrieved were also studied. Kaplan-Meier analysis, log-rank tests, and Cox-proportional hazard models were used, and P < .05 was considered to be significant.

RESULTS

OS was 77.5% at 10 years and 37.3% at 20 years; CSS was 88.6% at 10 years and 72.7% at 20 years. The hazard of mortality was higher in men who did not undergo PLND with a hazard ratio of 1.4 for OS (P = .2) and 2.7 for CSS (P = .01). No significant increase in OS or CC was seen with increasing number of lymph nodes retrieved. Some limitations are inherent to the SEER database and include the lack of hormone manipulation status and PSA data.

CONCLUSIONS

Excellent long-term survival can be achieved with SRP. PLND improves CSS but increasing nodal yield does not significantly improve survival. Small sample sizes limit the overall power of this study.