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

Abstract

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 ϭ 0.08). Nevertheless, in these two groups preoperative PSA, stage, and Gleason grade were significantly different (P Ͻ 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 optionfor 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.

Prostate‐specific antigen relapse‐free survival in patients with localized prostate cancer treated by brachytherapy

“…The results show similar PSA-RFS to those reported from other centres [3][4][5][6]11] but comparison is difficult because of differences in case mix and in length of follow-up. The effect of the key prognostic factors of PSA, Gleason score and risk group were confirmed, as in other studies.…”

“…with many patients to become available [2][3][4]. So far there have been relatively few reports from Europe, because the technique was adopted there more recently [5,6].…”

Motivations and influences on the use of complementary medicine in patients with localized prostate cancer treated with curative intent: results of a pilot study

“…Thus, another goal of the present study was to gather objective data about patients' opinions of the physician's reaction to the use of CM in those treated for localized prostate cancer with curative intent, as this has not been assessed before. In addition, the present patient cohort differs from those in previous studies because the patients chose 'state-of-the-art' conventional medical care for their cancer, as recommended by their physicians, and which has a high likelihood of cure [5,6]. Thus we sought to distinguish the main critics and advocates of CM, and to categorize possible differences between various medical specialities in their reactions to the use of CM among patients with prostate cancer.…”

Brachytherapy versus radical prostatectomy

“…In the BT group, the 7-year actuarial likelihood of freedom from biochemical progression (PSA <0.5 ng/mL) was 79%, and 88% when the de®nition of PSA failure recommended by ASTRO was used. As no randomized study is available, other authors [8,9] used the same methodology, comparing original RP series with the only BT study providing a long-term follow-up [10]. The results are similar in all series (e.g.…”