To report the long-term results of prostate brachytherapy followed by external beam irradiation (EBRT) in men with a positive seminal vesicle biopsy (+SVB). Materials and Methods 1981 men with localized prostate cancer were treated with permanent brachytherapy of which 615 had staging SVB and 53 (9. 4%) were positive. Higher stage, Gleason score and PSA were associated with a positive SVB (p<0.001). Patients with +SVB and negative laparoscopic pelvic lymph node dissection, bone and CT scans had 3 months of androgen deprivation therapy (ADT) followed by Pd-103 implant to the prostate (dose 100 Gy) and proximal SVs and 2 months later 45 Gy EBRT. ADT was continued for a median of 6 months (total ADT=9 months). Mean follow-up time was 9 years (range 5-16). Results Phoenix free failure, freedom from metastasis and cause specific survival (CSS) for patients with a negative SVB vs. positive SVB at 15 years was 76.3 vs. 60.6% (p=0.001), 95.4 vs. 78.2% (p<0.001) and 95 vs 70.4% (p<0.001), respectively. Prostate cancer death occurred in 45/590 (7.6%) in men without a +SVB vs. 8/25 (32%) in those with a +SVB (OR 5.7, 95%CI 2.3-13.9, p<0.001). Cox proportion hazard rates demonstrated Gleason score (p<0.001, HR 1.9), stage (p=0.010, HR 1.42), radiation dose (p=0.013, HR 0.991) and +SVB (p=0.001, HR 4.48) as significantly associated with CSS. Conclusions Men with a +SVB have inferior CSS compared to those with a -SVB. However, a strategy that included a SVB in high risk patients and implantation of the vesicles in men undergoing combination therapy still yields favorable long-term results. This article is protected by copyright. All rights reserved.
BJU international. 2018 Jun 29 [Epub ahead of print]
Nelson N Stone, Richard G Stock
Departments of Urology and Radiation Oncology The Icahn School of Medicine at Mount Sinai, New York, New York.