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Combined 3‐dimensional conformal radiotherapy and transperineal Pd‐103 permanent implantation for patients with intermediate and unfavorable risk prostate cancer
Author(s) -
Singh Andy,
Zelefsky Michael J.,
Raben Adam,
Lombardi Danna,
Leibel Steven A.
Publication year - 2000
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/1097-0215(20001020)90:5<275::aid-ijc4>3.0.co;2-m
Subject(s) - medicine , prostate cancer , prostate , radiation therapy , urology , cancer , oncology , radiology
Purpose To evaluate the efficacy and morbidity of combined 3‐dimensional conformal radiation therapy (3D‐CRT) and brachytherapy for intermediate/unfavorable risk prostate cancer. Materials and Methods Between May 1996 and November 1997, 65 patients with intermediate/unfavorable risk prostate cancer were treated with 3D‐CRT (50.4 Gy) followed by a transperineal permanent Pd‐103 implant. Patients with one or two adverse prognostic features (PSA > 10 and Gleason ≥ 7) were classified as intermediate risk and unfavorable risk, respectively. Forty‐seven patients (71%) had intermediate risk and 18 (29%) had unfavorable disease risk. The median age of this group was 65 years (range, 42–76 years), and the median pretreatment PSA level was 8.0 ng/ml (range, 1.7–42.0 ng/ml). The clinical stage of these patients was as follows: T1c, 36 (55%); T2a, 27 (42%); T2b/T3, 2 (3%). Fifteen patients (23%) had a Gleason ≤ 6, 41 patients (63%) were classified as Gleason 7, and 9 (14%) as Gleason ≥ 8. Fifty‐two (80%) received neoadjuvant androgen deprivation (NAAD) for cytoreduction. The median follow‐up was 36 months (range, 24–42 months). Results The PSA relapse‐free survival rate at 3 years was 87%, with a median PSA value at last follow‐up of 0.25 ng/ml. The relapse‐free survival was 90% for those who had an initial PSA ≤ 10 ng/ml and 80% for patients who had an initial PSA > 10 ng/ml ( p = 0.5). No difference in outcome was observed between patients with intermediate and unfavorable risk disease. Eight patients (13%) developed late Grade 2 rectal bleeding. Twenty‐three patients (42%) required medication for urinary symptoms during the first 6 months after therapy. Three patients (5%) noted rare stress incontinence at last follow‐up. Of the 44 patients who were potent prior to therapy, 17 (26%) developed erectile dysfunction (ED). Conclusion Although the follow‐up is short, the early biochemical outcome of combined 3D‐CRT and brachytherapy for intermediate/unfavorable risk prostate cancer is promising. While rectal toxicity is minimal, urinary side effects are more common. Further follow‐up is necessary to fully evaluate the efficacy of this combined therapeutic approach. Int. J. Cancer (Radiat. Oncol. Invest.) 90:275–280, 2000. © 2000 Wiley‐Liss, Inc.