Brachytherapy in localized prostate cancer with or without androgen deprivation

Blanco, Ana; Latorre, J. Anchuelo; Barceló, G. Payá; Carro, J. Cardenal; Rubio, E. Acuña; Rodríguez, J. Vázquez; Mazon, Josete; Gómez, Paula

doi:10.1016/j.rpor.2013.03.012

Cited by 4 publications

(2 citation statements)

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“…The preliminary results of the Spanish HDR RCT reported no benefit to ADT (119). Only one HDR study reported 11% and 20 % improved bPFS with ADT for IR and HR patients (88).…”

Section: Discussionmentioning

confidence: 99%

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American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

et al. 2017

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Introduction Prostate Brachytherapy (PB) has well-documented excellent long-term outcomes in all risk groups. There are significant uncertainties regarding the role of Androgen Deprivation Therapy (ADT) with brachytherapy. The purpose of this report is to review systemically the published literature and summarize present knowledge regarding the impact of ADT on Biochemical Progression Free Survival (bPFS), Cause Specific Survival (CSS) and Overall Survival (OS). Material and Methods A literature search was conducted in Medline and Embase covering the years 1996-2016. Selected were articles with >100 patients, minimum follow-up 3 years, defined risk stratification and directly examining the role and impact of ADT on bPFS, CSS and OS. The studies were grouped to reflect disease risk stratification. We also reviewed the impact of ADT on OS, cardiovascular morbidity, mortality, and ongoing brachytherapy Randomized Controlled Trials (RCTs). Results 52 selected studies (43,303 patients) were included in this review; 7 HDR (High Dose Rate), and 45 LDR (Low Dose Rate). Twenty-five studies were multi-institutional and 27 single institution, (retrospective review or prospective data collection) and two were RCTs. The studies were heterogeneous in patient population, risk categories, risk factors, follow-up time, and treatment administered, including ADT administration and duration (median 3-12 months). Seventy one percent of the studies reported a lack of benefit, while 28% show improvement in bPFS with addition of ADT to PB. The lack of benefit was seen in LR and favourable IR disease, as well as the majority of HDR studies. A bPFS benefit of up to 15% was seen with ADT use in: patients with suboptimal dosimetry, those with multiple adverse risk factors (unfavourable IR) and most HR studies. Four studies reported very small benefit to CSS (2%). None of the studies showed OS advantage, however 3 studies reported an absolute 5-20% OS detriment with ADT. Literature suggests OS detriment is more likely in older patients or those with pre-existing cardiovascular disease (CVD). Four RCTs with an adequate number of patients and well defined risk stratification are in progress. One RTC will answer the question regarding the role of ADT with PB in favourable IR patients, and the other 3 RTCs will focus on optimal duration of ADT in the unfavourable IR and favourable HR population. Conclusions Patients treated with brachytherapy have excellent long-term disease outcomes. Existing evidence shows no benefit of adding ADT to PB in LR and favourable IR patients. Unfavourable IR, HR patients and those with suboptimal dosimetry may have up to 15% improvement in bPFS with addition of 3-12 months of ADT, with uncertain impact on CSS and a potential detriment on OS. In order to minimize morbidity one should exercise caution in prescribing ADT together with PB, in particular to older men and those with existing CVD. Due to the retrospective nature of this evidence, significant selection and treatment bias, no definitive conclusions a...

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“…The preliminary results of the Spanish HDR RCT reported no benefit to ADT (119). Only one HDR study reported 11% and 20 % improved bPFS with ADT for IR and HR patients (88).…”

Section: Discussionmentioning

confidence: 99%

“…With median follow-up of 60 months, there was no benefit to ADT for bPFS (83% vs. 90% P = 0.4), and no benefit to loco regional control or distant metastasis (119). …”

Section: Ongoing Rcts (Table 6)mentioning

confidence: 97%