Patterns of recurrence after low-dose-rate prostate brachytherapy: A population-based study of 2223 consecutive low- and intermediate-risk patients - Abstract

OBJECTIVES: This study examined patterns of recurrence after low-dose-rate prostate brachytherapy (LDR-PB), estimated local recurrence rate and compared that rate to the estimated local recurrence rate after radical prostatectomy (RP).

METHODS AND MATERIALS: A prospective database was maintained with clinical, dosimetric, and outcome data for all LDR-PB implantation procedures performed at our institution. From 1998 to 2008, 2223 patients with prostate cancer received LDR-PB without supplemental external beam radiation therapy. Patients who developed Phoenix-defined biochemical failure were reviewed for sites of relapse and investigations completed.

RESULTS: At a median follow-up of 5 years, 108 of 2223 patients (4.8%) developed biochemical relapse. In 1 additional patient, local relapse was found on transurethral prostate resection, but his prostate-specific antigen concentration was well short of triggering Phoenix-defined failure. Of the 109 patients with disease relapse, 18 of 2223 (0.8%) had a proven local recurrence, and 30 of 2223 (1.3%) had a proven distant recurrence. The remaining 61 of 2223 patients (2.7%) had unidentified sites of recurrence; of these, 57 patients (93%) had digital rectal examinations (DREs), 18 (30%) had post-treatment biopsies, 45 (74%) had bone scans, and 34 (56%) had computed tomography imaging of the abdomen and pelvis. If every biochemical failure were local, the local recurrence rate would be as high as 4.9%; however, by excluding those with proven distant failure and those with both a negative DRE and biopsy, we estimate that the local recurrence rate is 2.7% or less.

CONCLUSIONS: In the context of limitations of the study design, our population-based analysis indicates that the local recurrence rate after LDR-PB is as low or lower than that after RP in our jurisdiction.

Written by:
Lo AC, Morris WJ, Pickles T, Keyes M, McKenzie M, Tyldesley S.   Are you the author?
Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.  

Reference: Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):745-51.
doi: 10.1016/j.ijrobp.2014.12.014


PubMed Abstract
PMID: 25752387

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