UroToday - Long-Term Prostate Cancer Control Using Palladium-103 Brachytherapy and External Beam Radiotherapy in Patients with a High Likelihood of Extracapsular Cancer Extension

Long-Term Prostate Cancer Control Using Palladium-103 Brachytherapy and External Beam Radiotherapy in Patients with a High Likelihood of Extracapsular Cancer Extension

Thursday, 22 March 2007

BERKELEY, CA (UroToday.com) - Brachytherapy is recommended for low risk prostate cancer (CaP). For intermediate and high risk patients, some have advocated combining brachytherapy with external beam radiotherapy (EBRT). In Urology, Dr. Dattoli and colleagues report their long term CaP outcomes using brachytherapy and EBRT in 243 patients.

The patients were staged with clinical T2 and T3 CaP and received palladium-103 plus supplemental EBRT from 1992 to 1996. Of the patient cohort, 243 had at least one higher risk feature; Gleason >7 in 192, PSA >10ng/ml in 166 and PAP level greater than 2.5U in 66 patients. Of the 243 participants, 135 had all three high-risk features. Staging pelvic lymphadenectomy and post-procedure biopsies were not performed. ERBT consisted of 41Gy to a limited pelvic field followed one month later by a Pd-103 boost. The minimal Pd-103 dose was 80-90 Gy. A median Pd-103 dose of 102mCi was implanted. Neoadjuvant or adjunctive androgen deprivation was given to 103 men, but not for longer than 6 months. Freedom from biochemical failure was defined as a serum PSA less than 0.2ng/ml. The median follow up period for all patients was 9 years.

A total of 41 men developed biochemical recurrence, and the overall actuarial freedom from biochemical progression rate at 13 years was 81%, with 198 men followed longer than 5 years. For the 93 patients with a Gleason score of 7 or greater or a PSA level of 10ng/ml or more, the overall freedom from biochemical failure was 72% at 10 years. Of those 41 patients experiencing biochemical failure, 27 (66%) developed failure within the first 3 years of treatment. Those patients with biochemical failure had follow-up prostate biopsies performed and no local failures were documented. Neoadjuvant and adjunctive androgen deprivation did not affect the failure rate in the 103 men who received it. The overall 5- and 10-year survival rate was 93% and 70%, respectively. Cancer-specific survival rates at 5- and 10-years were 97% and 84%, respectively. These data suggest good long-term local control in a cohort of men at risk for locally advanced disease.

Dattoli M, Wallner K, True L, Cash J, Sorace R

Urology 2007; 69(2):334-7

UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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