Patients treated for clinically node-positive prostate cancer (PCa) are at high risk of recurrence. Local radiation dose escalation with brachytherapy (BT) has been shown to improve outcomes in advanced localised disease, but evidence is lacking for patients with pelvic lymph node metastases.
We retrospectively collected data on patients treated for clinically node-positive PCa with definitive external beam radiation therapy (EBRT) and androgen-deprivation therapy (ADT), with or without dose-escalation to the prostate using high-dose-rate (HDR)-BT. The primary endpoint was metastasis-free survival (MFS). Toxicity was evaluated according to the RTOG/EORTC criteria. Survival analysis included propensity-score matching followed by log-rank tests, and multivariable Cox regression models.
We included 360 patients treated at eight centers between 2008 and 2023 with EBRT (100 %) and ADT (99.5 %), with a BT-boost to the prostate in approximately one third of the cases (33.6 %). No significant differences in MFS were observed between groups in a propensity-score matching analysis (median 84.6 vs. 77.7 months; p = 0.6); however, a subgroup analysis of patients with International Society of Urological Pathology (ISUP) 4-5 PCa (n = 139) indicated significantly improved MFS in those who received BT-boost (median 84.6 vs. 48.9 months; p = 0.007). BT-boost was an independent prognostic factor for MFS in a multivariable analysis accounting for ISUP (hazard ratio: 0.63; 95 % confidence interval: 0.4-0.98; p = 0.041). The incidence of late grade ≥ 2 gastrointestinal (GI) toxicity was significantly lower in patients treated with BT-boost (2.5 % vs. 10.9 %, p = 0.02).
BT-boost was not associated with improved outcomes in unselected patients treated with ADT and EBRT for clinically node-positive prostate cancer. However, subset analysis indicated that BT-boost was associated with improved outcomes in patients with ISUP grade 4-5 disease, and patients treated with BT-boost had lower rates of moderate or worse GI toxicity. Prospective studies are necessary to validate these findings.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2025 Aug 27 [Epub ahead of print]
Mateusz Bilski, Piotr Lelek, Magdalena Stankiewicz, Marcin Miszczyk, Wojciech Burchardt, Adam Kluska, Aleksandra Napieralska, Andrzej Kukiełka, Paweł Cisek, Katarzyna Konat-Bąska, Rafał Stando, Michał Dec, Ewelina Piliszczuk, Robert Matys, Tomasz Bajon, Maciej Trojanowski, Mathias Moll, Alfonso Gomez-Iturriaga, Adam Chicheł, Piotr Wojcieszek, Shahrokh F Shariat, Artur J Chyrek
Brachytherapy Department, Saint John's Cancer Center, Lublin, Poland; Radiotherapy Department, Saint John's Cancer Center, Lublin, Poland; Radiotherapy Department, Medical University of Lublin, Lublin, Poland., Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland. Electronic address: ., Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland; Electroradiology Department, University of Medical Sciences, Poznań, Poland., Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland., Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Branch Gliwice, Gliwice, Poland; Radiotherapy Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Branch Kraków, Kraków, Poland., Department of Radiotherapy, NU-MED Cancer Diagnostics and Therapy Centre, Zamość, Poland., Brachytherapy Department, Saint John's Cancer Center, Lublin, Poland; Radiotherapy Department, Medical University of Lublin, Lublin, Poland., Department of Brachyterapy, Lower Silesian Oncology Pulmonology and Hematology Center, Wroclaw, Poland., Department of Radiotherapy, Holy Cross Cancer Center, Kielce, Poland., Department of Radiotherapy, Gdynia Oncology Center, Gdynia, Poland., Radiotherapy Department, International Oncology Center, Koszalin, Poland., II Radiotherapy Department, Greater Poland Cancer Centre, Poznań, Poland., Greater Poland Cancer Registry, Greater Poland Cancer Centre, Poznań, Poland., MedAustron Centre for Ion Therapy and Research, Vienna Neustadt, Austria., Department of Radiation Oncology, Cruces University Hospital, Biobizkaia Health Research Institute, Basque Country University (UPV/EHU), Bilbao, Spain., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Division of Urology, Department of Special Surgery, University of Jordan, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Research Centre for Evidence Medicine, Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran., Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland; Electroradiology Department, University of Medical Sciences, Poznań, Poland. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40882818