Greater Biopsy Core Number Is Associated With Improved Biochemical Control in Patients Treated With Permanent Prostate Brachytherapy

Bittner, Nathan; Merrick, Gregory S.; Galbreath, Robert W.; Adamovich, Edward; Wallner, Kent E.

doi:10.1016/j.ijrobp.2010.02.068

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…It seems that the more prostate biopsies are performed, the more accurate the percentage of prostate biopsies will be as a prognosis factor [18]. The number of biopsy cores performed has been shown to be an independent prognosis factor for patients treated with brachytherapy [63]. The realization of targeted prostate biopsies, becoming more frequent with the generalization of pre-biopsy procedure prostate MRI, also distorts the evaluation of tumor burden.…”

Section: Discussionmentioning

confidence: 99%

Tumor burden and location as prognostic factors in patients treated by iodine seed implant brachytherapy for localized prostate cancers

et al. 2019

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BackgroundIodine seed implant brachytherapy is indicated for low risk and selected favorable intermediate risk prostate cancers. A percentage of positive biopsies > 50% is usually considered as a contra-indication, and the tumor location could also influence the treatment efficacy. We studied the association of the percentage of positive biopsy cores, and tumor location, with progression-free survival.MethodsAmong the 382 patients treated at our center by permanent implant iodine seed brachytherapy for a localized prostate cancer between 2006 and 2013, 282 had accessible detailed pathology reports, a minimum follow-up of 6 months, and were included. Progression was defined as a biochemical, local, nodal, or distant metastatic relapse. We studied cancer location on biopsies (base, midgland or apex of the prostate) and percentage of positive biopsy cores, as well as potential confounders (pre-treatment PSA, tumor stage, Gleason score, risk group according to D’Amico’s classification modified by Zumsteg, adjunction of androgen deprivation therapy, and dosimetric data).ResultsMost patients (197; 69.9%) had a low risk, 67 (23.8%) a favorable intermediate risk, 16 (5.7%) an unfavorable intermediate risk, and 1 (0.3%) a high-risk prostate cancer. An involvement of the apex was found for 131 patients (46,5%), of the midgland for 149 (52,8%), and of the base for 145 (51,4%). The median percentage of positive biopsy cores was 17% [3–75%]. The median follow-up was 64 months [12–140]. Twenty patients (7%) progressed: 4 progressions (20%) were biochemical only, 7 (35%) were prostatic or seminal, 6 (30%) were nodal, and 3 (15%) were metastatic. The median time to failure was 39.5 months [9–108]. There were more Gleason scores ≥7 among patients who progressed (40% vs 19%; p = 0.042). None of the studied covariates (including tumor location, and percentage of positive biopsy cores), were significantly associated with progression-free survival. The risk group showed a trend towards an association (p = 0.055).ConclusionsBrachytherapy is an efficient treatment (5-year control rate of 93%) for patients carefully selected with classical criteria. The percentage and location of positive biopsies were not significantly associated with progression-free survival. A Gleason score ≥ 7 was more frequent in case of progression.

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Section: Discussionmentioning

confidence: 99%

Tumor burden and location as prognostic factors in patients treated by iodine seed implant brachytherapy for localized prostate cancers

et al. 2019

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“…This may reflect a change in statistical tools available since publication of earlier catalogues [4]. Two of the survival models [28, 29] did not account for competing risks when predicting prostate cancer specific mortality, a potential weakness which could easily be addressed.…”

Section: Discussionmentioning

confidence: 99%

An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: a systematic review

Raymond¹,

O’Callaghan

Campbell

et al. 2017

Radiat Oncol

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BackgroundProstate cancer can be treated with several different modalities, including radiation treatment. Various prognostic tools have been developed to aid decision making by providing estimates of the probability of different outcomes. Such tools have been demonstrated to have better prognostic accuracy than clinical judgment alone.MethodsA systematic review was undertaken to identify papers relating to the prediction of clinical outcomes (biochemical failure, metastasis, survival) in patients with prostate cancer who received radiation treatment, with the particular aim of identifying whether published tools are adequately developed, validated, and provide accurate predictions. PubMed and EMBASE were searched from July 2007. Title and abstract screening, full text review, and critical appraisal were conducted by two reviewers. A review protocol was published in advance of commencing literature searches.ResultsThe search strategy resulted in 165 potential articles, of which 72 were selected for full text review and 47 ultimately included. These papers described 66 models which were newly developed and 31 which were external validations of already published predictive tools. The included studies represented a total of 60,457 patients, recruited between 1984 and 2009. Sixty five percent of models were not externally validated, 57% did not report accuracy and 31% included variables which are not readily accessible in existing datasets. Most models (72, 74%) related to external beam radiation therapy with the remainder relating to brachytherapy (alone or in combination with external beam radiation therapy).ConclusionsA large number of prognostic models (97) have been described in the recent literature, representing a rapid increase since previous reviews (17 papers, 1966–2007). Most models described were not validated and a third utilised variables which are not readily accessible in existing data collections. Where validation had occurred, it was often limited to data taken from single institutes in the US. While validated and accurate models are available to predict prostate cancer specific mortality following external beam radiation therapy, there is a scarcity of such tools relating to brachytherapy. This review provides an accessible catalogue of predictive tools for current use and which should be prioritised for future validation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-017-0786-z) contains supplementary material, which is available to authorized users.

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“…However, because of substantially different risks of extracapsular extension and seminal vesicle and/or pelvic lymph node involvement among the IR cohort [ 3 ], the prognosis of IR patients can vary dramatically. In addition, the NCCN risk group stratification does not account for additional adverse prognosticators including multiple IR factors [ 4 ], fewer diagnostic biopsy cores [ 5 ], and more than 50% of the biopsies positive [ 6 , 7 ], which can result in prostate specific antigen (PSA) recurrence rates and prostate cancer specific mortality (PCSM) consistent with high-risk disease. Recently, Zumteg and colleagues stratified IR patients into favorable and unfavorable categories with the conclusion that unfavorable IR (primary Gleason pattern 4, ≥ 50% positive biopsies or ≥ 2 intermediate-risk features) resulted in an increased risk of biochemical failure (BF), PCSM, and distant metastases (DM) when compared to favorable IR prostate cancer patients who were treated with dose-escalated intensity modulated external beam radiation therapy (IMRT) with or without 6 months of androgen deprivation therapy (ADT) [ 8 ].…”

Section: Purposementioning

confidence: 99%

Stratification of brachytherapy-treated intermediate-risk prostate cancer patients into favorable and unfavorable cohorts

Merrick¹,

Butler²,

Galbreath³

et al. 2015

jcb

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PurposeTo evaluate biochemical failure (BF) and prostate cancer specific mortality (PCSM) in intermediate-risk (IR) brachytherapy patients stratified into favorable and unfavorable cohorts, and to compare those outcomes to patients with low (LR) and high-risk (HR) disease.Material and methodsFrom March 1995 till February 2012, 2,502 consecutive patients underwent permanent interstitial brachytherapy for clinically localized prostate cancer. Patients were stratified into risk groups as per the NCCN guidelines with further stratification of the intermediate risk cohort into unfavorable (primary Gleason pattern 4, ≥ 50% positive biopsies or ≥ 2 IR features) and favorable cohorts. Median follow-up was 8.5 years. The brachytherapy prescription dose was prescribed to the prostate gland with generous periprostatic margins. Biochemical failure was defined as a PSA > 0.40 ng/ml after nadir. Patients with metastatic prostate cancer or non-metastatic castrate resistant disease who died of any cause were classified as dead of prostate cancer. Multiple parameters were evaluated for effect on outcomes.ResultsFifteen year BF for LR, favorable IR, unfavorable IR, and HR were 1.4%, 2.2%, 7.1%, and 11.1% (p < 0.001), respectively. At 15 years, PCSM for LR, favorable IR, unfavorable IR, and HR was 0.3%, 0.6%, 2.2% and 4.6% (p < 0.001), respectively. In multivariate analysis, BF was best predicted by risk group, pre-implant PSA, percent positive biopsies, prostate volume, and ADT duration, while PCSM was most closely related to risk group, percent positive biopsies and prostate volume.ConclusionsPatients with favorable IR disease have biochemical and PCSM outcomes comparable to those of patients with LR disease. Although unfavorable IR has greater than a 3-fold increased risk of BF and PCSM when compared to favorable IR, the outcomes remain superior to those men with HR disease.

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Greater Biopsy Core Number Is Associated With Improved Biochemical Control in Patients Treated With Permanent Prostate Brachytherapy

Cited by 7 publications

References 16 publications

Tumor burden and location as prognostic factors in patients treated by iodine seed implant brachytherapy for localized prostate cancers

Tumor burden and location as prognostic factors in patients treated by iodine seed implant brachytherapy for localized prostate cancers

An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: a systematic review

Stratification of brachytherapy-treated intermediate-risk prostate cancer patients into favorable and unfavorable cohorts

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