25-Year Disease-Free Survival Rate After Irradiation for Prostate Cancer Calculated with the Prostate Specific Antigen Definition of Recurrence Used for Radical Prostatectomy

Critz, Frank A.; Benton, James; Shrake, Philip D.; Merlin, Mark

doi:10.1016/j.juro.2012.10.061

Cited by 48 publications

(30 citation statements)

References 14 publications

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“…12 Critz et al used a definition of <0.2 ng/ mL for BCR to compare their results post-PB with patients treated by RP and analyzed for low-, intermediate-and highrisk cancers over the same time range. 11 Using the same definition (<0.2 ng/ml) for both treatment modalities (PB vs. RP) gave similar results for 10-and 15-year DFS. Selecting patients who are treated during the same time span allows for comparison of Gleason scores and PSA levels that prescribe a therapy for active surveillance or initiate active treatment.…”

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confidence: 70%

A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer

Taussky

Ouellet

Delouya

et al. 2016

CUAJ

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Introduction: We sought to compare the outcomes between radical prostatectomy (RP) and permanent seed prostate brachytherapy (PB) in patients with low-and low-intermediate-risk prostate cancer from a single tertiary care centre. Methods: Patients were selected from our institute's internal database based on preoperative selection criteria from the National Comprehensive Cancer Network (NCCN) guidelines (2015) for low-and intermediate-risk patients. No patient had received any neo-adjuvant androgen-deprivation therapy. The endpoint was biochemical recurrence (BCR) or any salvage treatment for both RP and PB at 48 ± 4 months after treatment. The biochemical relapse threshold was set at prostate-specific antigen (PSA) ≥0.5 ng/mL for PB and two PSA values of ≥0.2 ng/mL for RP. Patients from both treatment groups were compared using non-parametric tests. A binary logistic regression analysis was performed to determine an association of treatment and pretreatment factors with a BCR at 48 months. Results: A total of 575 patients were included in this study; 254 were treated with RP and 321 with PB. BCR was not different between both groups (p=0.84, Chi-square test), and occurred in 21.2% of patients treated with RP and in 20.6% with PB. Based on univariate and multivariate logistic regression analyses, younger age, higher percentage of positive biopsies, and initial PSA were predictive of BCR. IntroductionRadical prostatectomy (RP) and permanent seed prostate brachytherapy (PB) are two widely used treatment options for patients with low-and intermediate-risk prostate cancer. Both treatments are similar for excellent cancer control rates and patients often have difficulty deciding between the two. Published studies for both treatments are difficult to compare because of different definitions for recurrence and differences in baseline characteristics, such as age and comorbidity. Attempts at randomized, prospective trials comparing both treatments have failed because patients ultimately prefer to make their own treatment decisions.1 Furthermore, different definitions of biochemical recurrence (BCR) have been proposed for each treatment. The American Urological Association Prostate Cancer guideline panel recently recommended standardizing the definition of BCR after RP to an initial prostate-specific antigen (PSA) level of 0.2 ng/mL or greater, with a second confirmatory PSA level of 0.2 ng/mL or greater.2 The American Society for Therapeutic Radiology and Oncology considers BCR as a rise by 2 ng/mL or more above the nadir PSA (Phoenix definition). 3In this study, we compared patients treated with either RP or PB at a single university hospital, using closely related definitions of BCR. We defined BCR after RP as a PSA level of ≥0.2 ng/mL and BCR after PB as ≥0.5 ng/mL, at four years post-treatment. MethodsWith ethical review board approval, patients were selected as they underwent treatment for their prostate cancer at the

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confidence: 70%

A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer

Taussky

Ouellet

Delouya

et al. 2016

CUAJ

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“…This early report is a retrospective multicentre cohort study and gives an efficient picture of the practice of BT in Italy, including 20 but there may be an increased toxicity, 21 and LDR-BT alone can produce excellent biochemical control for low-as well as intermediate-risk disease. 4 Approximately 40% of patients in the present series had previously undergone neoadjuvant AD therapy for 3-6 months.…”

Section: Discussionmentioning

confidence: 99%

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

Fellin¹,

Mirri²,

Santoro³

et al. 2016

BJR

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OBJECTIVE:\ud Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure.\ud METHODS:\ud Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes.\ud RESULTS:\ud Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT.\ud CONCLUSION:\ud This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer.\ud ADVANCES IN KNOWLEDGE:\ud Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome

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“…However, using different definitions to compare the oncologic outcome of radiation therapy to that of radical prostatectomy is questionable. To address this issue, Critz et al reported the oncologic outcome in patients who received LDR-brachytherapy in combination with EBRT using the same definition for biochemical recurrence as that for surgery [15]. They concluded that the biochemical recurrence-free rate was similar to that of radical prostatectomy using a large cohort study.…”

Section: Discussionmentioning

confidence: 99%

The biochemical recurrence-free rate in patients who underwent prostate low-dose-rate brachytherapy, using two different definitions

et al. 2014

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BackgroundTo assess the biochemical recurrence (BCR)-free rate in patients who underwent prostate low-dose-rate brachytherapy (LDR-brachytherapy), using two different definitions (Phoenix definition and PSA ≥ 0.2 ng/mL).MethodsTwo hundreds and three patients who were clinically diagnosed with localized prostate cancer (cT1c-2cN0M0) and underwent LDR-brachytherapy between July 2004 and September 2008 were enrolled. The median follow-up period was 72 months. We evaluated the BCR-free rate using the Phoenix definition and the PSA cut-off value of 0.2 ng/mL, as in the definition for radical prostatectomy. To evaluate an independent variable that can predict BCR, Cox’s proportional hazard regression analysis was carried out.ResultsThe BCR-free rate in patients using the Phoenix definition was acceptable (5-year: 92.8%). The 5- year BCR-free rate using the strict definition (PSA ≥ 0.2 ng/mL) was 74.1%. Cox’s proportional hazard regression analysis showed that a higher biological effective dose (BED) of ≥180 Gy2 was the only independent variable that could predict BCR (HR: 0.570, 95% C.I.: 0.327-0.994, p = 0.048). Patients with a higher BED (≥180 Gy2) had a significantly higher BCR-free rate than those with a lower BED (<180 Gy2) (5-year BCR-free rate: 80.5% vs. 67.4%).ConclusionsA higher BED ≥180 Gy2 promises a favorable BCR-free rate, even if the strict definition is adopted.

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25-Year Disease-Free Survival Rate After Irradiation for Prostate Cancer Calculated with the Prostate Specific Antigen Definition of Recurrence Used for Radical Prostatectomy

Cited by 48 publications

References 14 publications

A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer

A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

The biochemical recurrence-free rate in patients who underwent prostate low-dose-rate brachytherapy, using two different definitions

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