Biochemical outcomes for patients with intermediate risk prostate cancer treated with I-125 interstitial brachytherapy monotherapy

Abstract Background and purpose Routine use of I-125 interstitial brachytherapy (BT) alone in intermediate risk (IR) prostate cancer is controversial. It is often combined with external beam radiotherapy (EBRT). The biochemical outcome of a large cohort of only IR disease treated with BT monotherapy...

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Published in:	Radiotherapy and oncology Vol. 109; no. 2; pp. 235 - 240
Main Authors:	Tran, Anna Thi Huyen, Mandall, Paula, Swindell, Ric, Hoskin, P.J, Bottomley, David Martin, Logue, John Paul, Wylie, James Pinson
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier Ireland Ltd 01-11-2013
Subjects:	Aged Aged, 80 and over Brachytherapy Brachytherapy - methods Hematology, Oncology and Palliative Medicine Humans Intermediate risk Iodine Radioisotopes - therapeutic use Male Middle Aged Prostate cancer Prostate-Specific Antigen - blood Prostatic Neoplasms - blood Prostatic Neoplasms - radiotherapy Risk Treatment Outcome Prostate cancer Brachytherapy Intermediate risk
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Summary:	Abstract Background and purpose Routine use of I-125 interstitial brachytherapy (BT) alone in intermediate risk (IR) prostate cancer is controversial. It is often combined with external beam radiotherapy (EBRT). The biochemical outcome of a large cohort of only IR disease treated with BT monotherapy is reported. Materials and methods Between 2003 and 2007, 615 patients with Memorial Sloan-Kettering Cancer Centre (MSKCC) defined IR disease (one risk factor only-T2b, or Gleason score (GS) 7, or raised initial PSA (iPSA) 10.1–20 ng/ml) were treated with BT monotherapy. ASTRO (3 consecutive rises) and Phoenix (nadir plus 2) criteria defined biochemical failure. Potential prognostic factors (pre- and post-implant dosimetric indices, GS 3 + 4 versus 4 + 3, androgen deprivation therapy (ADT)) were analysed. Results Median follow-up was 5.0 years. Forty-three patients had stage T2b, 180 had raised iPSA, 392 had GS 7 disease. ADT was received by 108 patients. The 5-year biochemical no evidence of disease (bNED) rates are 87.3% (by ASTRO), 88.6% (by Phoenix). Stratification by risk factor (T2b, GS7, raised iPSA) demonstrated raised iPSA to have poorer outcome only by Phoenix criteria ( p = 0.0002). Other potential prognostic variables were non-significant. Conclusion Good rates of biochemical control can be achieved in the medium term with BT monotherapy in IR disease. Raised iPSA correlated with a poorer outcome.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0167-8140 1879-0887
DOI:	10.1016/j.radonc.2013.05.030