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Stage T3b prostate cancer diagnosed by seminal vesicle biopsy and treated with neoadjuvant hormone therapy, permanent brachytherapy and external beam radiotherapy
Author(s) -
Stone Nelson N.,
Stock Richard G.
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14464
Subject(s) - prostate cancer , medicine , brachytherapy , androgen deprivation therapy , urology , hazard ratio , radiation therapy , prostate , oncology , cancer , confidence interval
Objectives To report the long‐term results of prostate brachytherapy followed by external beam radiotherapy ( EBRT ) in men with a positive seminal vesicle biopsy (+ SVB ). Patients and Methods In all, 1081 men with localised prostate cancer were treated with permanent brachytherapy, of which 615 had staging SVB and 53 (9.4%) were positive. Higher stage, Gleason score and PSA level were associated with a + SVB ( P < 0.001). Patients with + SVB and negative laparoscopic pelvic lymph node dissection, bone and CT scans had 3 months of androgen‐deprivation therapy ( ADT ) followed by 103 Pd implant to the prostate (dose 100 Gy) and proximal SV s, and 2 months later 45 Gy EBRT . ADT was continued for a median of 6 months (total ADT 9 months). The mean (range) follow‐up was 9 (5–22) years. Results Biochemical freedom from failure (computed by the Phoenix definition), freedom from metastasis, and cause‐specific survival ( CSS ) for patients with a negative SVB (–SVB) vs + SVB at 15 years, was 76.3% vs 60.6% ( P = 0.001), 95.4% vs 78.2% ( P < 0.001), and 95% vs 70.4% ( P < 0.001), respectively. Prostate cancer death occurred in 45 of 590 (7.6%) men with a – SVB vs eight of 25 (32%) with a + SVB ( odds ratio 5.7, 95% confidence interval 2.35–13.9, P < 0.001). Cox proportion hazard rates (HRs) demonstrated Gleason score ( P < 0.001, HR 1.9), stage ( P = 0.010, HR 1.42), RT dose ( P = 0.013, HR 0.991), and + SVB ( P = 0.001, HR 4.48), as significantly associated with CSS . Conclusions Men with a + SVB have inferior CSS compared to those with a − SVB . However, a strategy that included a SVB in high‐risk patients and implantation of the SVs in men undergoing combined therapy still yields favourable long‐term results.