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Favourable long‐term outcomes with brachytherapy‐based regimens in men ≤60 years with clinically localized prostate cancer
Author(s) -
Kollmeier Marisa A.,
Fidaleo Anthony,
Pei Xin,
Cohen Gil'ad,
Zaider Marco,
Mo Quincy,
Cox Brett,
Yamada Yoshiya,
Zelefsky Michael J.
Publication year - 2013
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.2012.11663.x
Subject(s) - medicine , prostate cancer , brachytherapy , cancer , oncology , radiation therapy , proportional hazards model , common terminology criteria for adverse events , cohort , urology , genitourinary system , hormonal therapy , gynecology
What's known on the subject? and What does the study add? Brachytherapy ( BT )‐based treatment for clinically localized prostate cancer is a well‐accepted treatment strategy; however, there is concern that long‐term outcomes and morbidity may not be acceptable in young patients (≤60 years). We report our long‐term experience with BT in men aged ≤ 60 years with a minimum of 2 years of post‐treatment follow‐up. Our results show low treatment‐related morbidity and excellent long‐term outcomes with BT ‐based treatment and suggest that such treatment should be offered to this patient population.Objective To report long‐term outcomes of men ≤60 years treated with brachytherapy ( BT ) for low‐ and intermediate‐risk prostate cancer.Patients and Methods Of 1655 patients treated with BT for clinically localized prostate cancer between J anuary 1998 and M ay 2008 at M emorial S loan‐ K ettering C ancer C enter, 236 patients with N ational C omprehensive C ancer N etwork low‐ ( n = 178) or intermediate‐risk ( n = 58) prostate cancer were ≤60 years old with a 3‐year minimum follow‐up, and represent the subjects of this report. Brachytherapy was given either as monotherapy ( n = 169) or with external beam radiation therapy ( EBRT ; n = 67). Forty‐four patients (19%) received neoadjuvant cytoreductive hormone therapy. The ‘nadir+2’ definition was used for prostate‐specific antigen ( PSA ) recurrence. Common Terminology Criteria for Acute Events (CTCAE) v 3.0 was used to grade genitourinary ( GU ) and gastrointestinal ( GI ) toxicity. Potency was defined as the ability to obtain an erection suitable for intercourse or an I nternational I ndex of E rectile F unction score ≥ 22. The K aplan– M eier method and Cox regression were used for statistical analysis. The median follow‐up was 83 months.Results The 8‐year PSA relapse‐free survival ( RFS ), cancer‐specific and overall survival rates for the entire cohort were 96, 99 and 96%, respectively. For patients with low‐risk disease, the 8‐year PSA RFS rate was 97% and for intermediate‐risk patients it was 94% ( P = 0.34). There was no difference in PSA RFS between BT alone and combined therapy ( P = 0.17). Late grade ≥ 2 GU and GI toxicity was 14 and 3%, respectively. Of 150 patients potent before treatment, 76 (51%) were potent at last follow‐up, with 50/76 (66%) using no medication. There was no significant difference in post‐treatment potency between BT alone and BT with EBRT ( P = 0.74).Conclusions Brachytherapy provides patients aged ≤ 60 years with low‐ and intermediate‐risk prostate cancer with excellent outcomes and has a low risk of significant long‐term GU or GI morbidity. Erectile function is preserved in >50% of patients and the majority do not require erectile dysfunction medication.