Clinical and Biochemical Evidence of Control of Prostate Cancer at 5 Years After External Beam Radiation

Hanks, Gerald E.; Lee, W. Robert; Schultheiss, Timothy E.

doi:10.1016/s0022-5347(01)67073-3

Cited by 93 publications

(13 citation statements)

References 14 publications

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“…In our series, the most significant cutoff which revealed a difference in biochemical failure was a PSA of 20 ng/ml; patients with PSA > 20 had only a 34% FFBF at 4 years. These results are similar to those found after both radical prostatectomy and external beam irradiation [18][19][20][21].…”

Section: Discussionsupporting

confidence: 90%

The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy

Stock¹,

Stone²

1997

Semin. Surg. Oncol.

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The objectives of this study were to examine the effect of both disease and treatment related prognostic factors on biochemical control and post‐treatment biopsy. Two‐hundred fifty‐eight patients underwent interactive ultrasound guided transperineal prostate implantation for T1‐T2 prostate cancer using Iodine‐125 (139 patients) and Palladium‐103 (119 patients) and were followed from 6‐67 months (median, 19). Hormonal therapy with 3 months of leuprolide and flutamide prior to implantation and two months given after the implant was used in 96 patients. Pre‐treatment prostate‐specific antigen (PSA) had the most significant effect on biochemical failure. Freedom from biochemical failure (FFBF) rates at 4 years were 75% for patients with PSA 1.3‐10 ng/ml (144), 74% for patients with PSA 10.1‐20 ng/ml (73), and 34% for patients with PSA > 20 ng/ml (41) (P = 0.0004). Gleason score also had a significant effect on FFBF rates. Four‐ year rates were 81%, 65% and 47% for patients with scores of 2‐4 (68), 5‐6 (130), and ≥7 respectively (60) (P = 0.01). These two factors were also significant in multivariate analysis (P = 0.002, 0.007, respectively). Gleason score was the only factor to significantly affect post‐treatment biopsy results. Patients with scores of 2‐6 had 85% (63/74) negative 2‐year biopsies versus 62% (13/21) for patients with scores ≥7 (P = 0.02). Low‐risk patients ( PSA ≤ 10 ng/ml, scores <7 and stage < T2a) had a 4‐year FFBF rate of 88% as compared to 60% for high‐risk patients (PSA > 10 ng/ml, score > 6 or stage≥ T2b) (P = 0.02) and had a 95% negative biopsy rate versus 76% for high‐risk patients (P = 0.06). Low‐risk patients demonstrate high FFBF and negative biopsy rates following implantation. Patients presenting with higher risk prognostic factors such as PSA > 20 ng/ml or Gleason scores ≥ 7 may require more aggressive treatment regimens. Semin. Surg. Oncol. 13:454‐460, 1997. © 1997 Wiley‐Liss, Inc.

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Section: Discussionsupporting

confidence: 90%

The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy

Stock¹,

Stone²

1997

Semin. Surg. Oncol.

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“…However, with the advent of more sophisticated follow‐up evaluations, notably serial PSA determinations and repeat biopsies, the local failure rates were found to be much higher than once thought 26, 29‐35. Table 5 shows 5‐year and 10‐year outcome comparisons between the brachytherapy study and several external beam irradiation series 33, 36‐42. These data suggest that patients treated with brachytherapy with or without 45‐Gy external beam radiation supplement fare better than patients treated with external beam irradiation as monotherapy.…”

Section: Discussionmentioning

confidence: 97%

Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high gleason grade prostate carcinoma

Ragde

Elgamal

Snow³

et al. 1998

Cancer

318

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BACKGROUND The authors report observed 10‐year brachytherapy results in the treatment of 152 consecutive patients with clinically organ‐confined prostate carcinoma. METHODS One hundred and fifty‐two consecutive patients with T1‐T3, low to high Gleason grade, prostate carcinoma were treated between January 1987 and June 1988 at Northwest Hospital in Seattle, Washington. Their median age was 70 years (range, 53‐92 years). Of these 152 patients, 98 (64%) received an iodine‐125 implant alone (Group 1), and the remaining 54 patients (36%), who were judged to have a higher risk of extraprostatic extension, also were treated with 45 gray (Gy) of external beam irradiation to the pelvis (Group 2). No patient underwent lymph node sampling, and none received androgen ablation therapy. Multivariate regression and the Mann‐Whitney rank sum test were used for statistical analysis. Preoperative patient data with associated success or failure outcomes at 10 years after treatment were used for training and validating a back‐propagation neural network prediction program. RESULTS The average preoperative prostate specific antigen (PSA) value, clinical stage, and Gleason grade were 11.0 ng/mL, T2, and 5, respectively. The median posttreatment follow‐up was 119 months (range, 3‐134 months). Overall survival 10 years after treatment was 65%. At last follow‐up only 3 of the 152 patients (2%) had died of prostate carcinoma. Ninety‐seven patients (64%) remained clinically and biochemically free of disease at 10 years of follow‐up and had an average PSA value of 0.18 ng/mL (range, 0.01‐0.5 ng/mL). In these patients a period of 42 months was required to reach the average PSA (0.5 ng/mL). The median to last PSA follow‐up was 95 months (range, 3‐134 months). Postoperative needle biopsies were negative in 56% of patients, positive in 15% of patients, and not available in 29% of patients. Only 6% of patients developed bone metastasis. At 10 years there was no statistically significant difference in treatment outcome between patients who received iodine‐125 alone, and those who received iodine‐125 with 45‐Gy external beam irradiation (P = 0.08). Nevertheless, in these two groups preoperative PSA, stage, and Gleason grade were significantly different (P < 0.01). In the artificial neural network analysis, pretreatment serum PSA was the most accurate predictor of disease‐free survival. CONCLUSIONS Percutaneous prostate brachytherapy is a valid and efficient option for treating patients with clinically organ‐confined, low to high Gleason grade, prostate carcinoma. Observed 10‐year follow‐up documents serum PSA levels superior to those reported in several published external beam irradiation series, and comparable to those published in a number of published radical prostatectomy series. Cancer 1998;83:989‐1001. © 1998 American Cancer Society.

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“…[3][4][5][6][7] Most large single-institution series now report that pretreatment serum prostatespecific antigen (PSA) values, Gleason score (GS), and palpation stage are significant independent predictors of a successful outcome following either surgery or radiation therapy. [8][9][10][11][12][13][14][15][16] A successful outcome now requires that the patient has no PSA-based evidence of relapse with long-term follow-up. 1,2,7,8,17 Longterm follow-up for patients treated with external beam radiation in the PSA era (since 1988 when PSA values began to direct earlier diagnosis) is limited to fewer than 10 years; thus, most singleinstitution series have only a small number of treated patients with follow-up of more than 5 years.…”

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confidence: 99%

Radiation Therapy for Clinically Localized Prostate Cancer

Shipley¹,

Thames²,

Sandler³

et al. 1999

JAMA

414

139

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Clinical and Biochemical Evidence of Control of Prostate Cancer at 5 Years After External Beam Radiation

Cited by 93 publications

References 14 publications

The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy

The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy

Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high gleason grade prostate carcinoma

Radiation Therapy for Clinically Localized Prostate Cancer

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