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The relevance of prostatectomy findings for brachytherapy selection in patients with localized prostate carcinoma
Author(s) -
Pisansky Thomas M.,
Blute Michael L.,
Hillman David W.,
Davis Brian J.,
Haddock Michael G.,
Suman Vera J.,
Wilson Torrence M.,
Zincke Horst
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10698
Subject(s) - medicine , prostatectomy , brachytherapy , prostate cancer , lymph node , prostate , urology , logistic regression , prostate specific antigen , carcinoma , biopsy , radiology , oncology , cancer , radiation therapy
BACKGROUND The efficacy of brachytherapy for patients with localized prostate carcinoma depends on adequate radiotherapeutic coverage of the primary tumor and its subclinical extraprostatic extensions. Predictive models based on pretherapy factors may be useful to estimate the likelihood for clinically relevant extraprostatic disease and may be incorporated into selection criteria for this procedure. METHODS Multivariate logistic regression model building was performed using pretherapy factors in 2905 surgically staged patients with localized prostate carcinoma to estimate the probability of seminal vesicle and/or lymph node involvement. Bootstrap methods were employed to assess the stability of the final model parameters and to determine the sensitivity and specificity of the final model. RESULTS Clinical tumor classification, biopsy Gleason score groupings, and serum prostate specific antigen (PSA) levels were associated with seminal vesicle and/or pelvic lymph node involvement. These factors were incorporated into a multivariate model that predicted for these adverse histopathologic features. Allowing for up to a 10% likelihood for seminal vesicle and/or pelvic lymph node involvement, patients with tumors classified as T1c–T2a, Gleason scores of 2–6, and PSA ≤ 16 ng/mL; or with tumors classified as T1c–T2a, Gleason scores of 7–10, and PSA ≤ 4 ng/mL; or with tumors classified as T2b–T2c, Gleason scores of 2–6, and PSA ≤ 6 ng/mL would be potential candidates for brachytherapy alone. CONCLUSIONS The predictive model presented may provide criteria whereby an adequately performed prostate brachytherapy procedure is expected to encompass the intraprostatic and adjacent extraprostatic disease. Prostate brachytherapy alone may be considered in these circumstances, whereas the addition of external beam radiotherapy may be reserved for patients with disease that is apt to extend beyond the brachytherapy target volume. Cancer 2002;95:513–9. © 2002 American Cancer Society. DOI 10.1002/cncr.10697