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Outcomes for patients with high‐grade prostate cancer treated with a combination of brachytherapy, external beam radiotherapy and hormonal therapy
Author(s) -
Stock Richard G.,
Cesaretti Jamie A.,
Hall Simon J.,
Stone Nelson N.
Publication year - 2009
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/j.1464-410x.2009.08661.x
Subject(s) - medicine , prostate cancer , brachytherapy , urology , radiation therapy , hormonal therapy , regimen , external beam radiotherapy , prostate specific antigen , prostate , oncology , multivariate analysis , cancer , gynecology
OBJECTIVE To assess the outcomes for patients with Gleason score 8–10 prostate cancer treated with brachytherapy, external beam radiotherapy (EBRT) and hormonal therapy (HT). PATIENTS AND METHODS In all, 181 patients with Gleason scores 8–10 prostate cancer were treated from 1994 to 2006 with a 103 Pd implant (prescription dose 100 Gy), 45 Gy of EBRT and 9 months of HT. The median (range) follow‐up was 65 (24–150) months; freedom from biochemical failure (FBF) rates were calculated using the Phoenix definition. RESULTS The 8‐year actuarial FBF, freedom from distant metastases, prostate‐cancer specific survival and overall survival were 73%, 80%, 87% and 79%, respectively. The pretreatment prostate‐specific antigen (PSA) level significantly affected FBF, with 8‐year rates of 72%, 82% and 58% for patients with PSA level of ≤10, >10–20 and >20 ng/mL, respectively ( P = 0.006). The PSA level had no significant effect on rates of distant metastases. The Gleason score had the most significant affect on FBF in a multivariate analysis, and was the only factor to significantly affect rates of distant metastases; the 8‐year FBF rates were 84%, 55% and 30% for scores of 8, 9 and 10, respectively ( P = 0.003). The corresponding freedom from distant metastases and prostate‐cancer specific survival rates were 86%, 76%, 30% ( P < 0.001) and 92%, 80%, 62.5% ( P = 0.003), respectively. CONCLUSIONS The 8‐year outcomes after this regimen showed favourable biochemical and distant control, as well disease‐specific survival rates for patients with Gleason scores of 8–10. This treatment approach should be considered as a viable option for this subset of patients with high‐risk disease.