International Journal of Radiation Oncology*Biology*Physics
Clinical investigationProstate15-Year biochemical relapse free survival in clinical Stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience
Introduction
Prostate brachytherapy continues to be a first-line treatment option for men with clinical stage T1-T2 prostate cancer. Technical advances are regularly reported, including the use of transrectal ultrasound guidance for preplanned or intraoperatively planned implants (1, 2, 3). Postimplant dosimetry has led to improved prostate coverage and a better understanding of the tolerances of adjacent critical structures (4). Data from the retropubic era showed that those patients with B1 (T2a) disease who received “adequate” implant dosimetry (based on orthogonal X-rays) achieved disease control rates similar to radical prostatectomy and external beam radiation therapy (EBRT) patients from that era (5). Improved implant quality has been demonstrated to result in better biochemical relapse-free survival (BRFS) outcomes in several modern studies (6, 7, 8).
Today’s improved patient selection and improved implant quality has resulted in multiple brachytherapy reports demonstrating 5–10 year BRFS rates are equivalent to the best published radical prostatectomy and three-dimensional conformal radiation therapy results (8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21). We report the Seattle 15-year results of transperineal interstitial permanent prostate brachytherapy combined with moderate-dose neoadjuvant EBRT in a group of consecutively treated and prospectively followed patients with clinical T1-T3 prostate cancer.
Section snippets
Methods and materials
This is a prospective cohort study. Between January 1987 and December 1993, 232 patients presenting with clinically localized prostate cancer were consecutively treated with I125/Pd103 brachytherapy with neoadjuvant EBRT.
Seven patients did not meet the initial cohort criteria for inclusion because of androgen ablation therapy for downsizing purposes and 1 patient had inadequate follow-up, reducing the analytic cohort to 223. Median follow-up time was 9.43 years ranging from 0.62 to 17.07 years.
Results
The clinical status at presentation is outlined in Table 1. The mean pretreatment PSA was 15.25 ng/mL, 63.3% of patients presented with T2b-T3 disease by DRE, and 35% had Gleason score 7-10. There were seven local failures (3.1%) based on a positive biopsy, or positive DRE, or androgen ablation therapy for suspected local recurrence.
The Kaplan-Meier BRFS for the entire study group is 74%, as depicted in Fig. 1. The BRFS by biopsy Gleason score, initial PSA, and clinical stage are shown in Fig. 2
Discussion
We report the 15-year BRFS results of 223 consecutively treated clinical T1-T3 prostate cancer patients. Patients were treated with 45 Gy EBRT followed a few weeks later by a transperineal template-guided transrectal ultrasound-guided permanent interstitial implant with I125 or Pd103 radioactive seeds. None of these patients received hormonal therapy. The neoadjuvant EBRT was given because the authors felt these patients were at significant risk for extracapsular or seminal vesicle disease
Conclusion
The 15-year BRFS outcomes with neoadjuvant EBRT and I125/Pd103 boost continue to show excellent long-term disease control rates despite a relatively unfavorable patient population, older era of treatment, and less sophisticated EBRT and brachytherapy techniques than are available.
Acknowledgments
The authors would like to thank Jonathan Khanjian for assisting in the preparation of this manuscript.
References (37)
- et al.
A comparison of radiation dose to the bulb of the penis in men with and without prostate brachytherapy-induced erectile dysfunction
Int J Radiat Oncol Biol Phys
(2001) - et al.
A dose-response study for I-125 prostate implants
Int J Radiat Oncol Biol Phys
(1998) - et al.
A comprehensive review of CT-based dosimetry parameters and biochemical control in patients treated with permanent prostate brachytherapy
Int J Radiat Oncol Biol Phys
(2001) - et al.
10-year biochemical (prostate-specific antigen) control of prostate cancer with 125-I brachytherapy
Int J Radiat Oncol Biol Phys
(2001) - et al.
Palladium-103 brachytherapy for prostate carcinoma
Int J Radiat Oncol Biol Phys
(2000) - et al.
Prognostic role of serum prostatic acid phosphatase for 103Pd-based radiation for prostatic carcinoma
Int J Radiat Oncol Biol Phys
(1999) - et al.
Biochemical disease-free survival following I-125 prostate implantation [Abstract]
Int J Radiat Oncol Biol Phys
(1995) - et al.
Five-year biochemical outcome following permanent interstitial brachytherapy for clinical T1-T3 prostate cancer
Int J Radiat Oncol Biol Phys
(2001) - et al.
High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer
J Urol
(2001) - et al.
Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: The Seattle experience
Int J Radiat Oncol Biol Phys
(2003)
Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995
Int J Radiat Oncol Biol Phys
Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: Long term results
J Urol
Evolution of the presentation and pathologic and biochemical outcomes after radical prostatectomy for patients with clinically localized prostate cancer diagnosed during the PSA era
Urology
Improvement in relapse-free survival throughout the PSA era in patients with localized prostate cancer treated with definitive radiotherapy: Year of treatment an independent predictor of outcome
Int J Radiat Oncol Biol Phys
Long-term biochemical disease-free and cancer-specific survival following anatomic radical retroprubic prostatectomyThe 15-year John Hopkins experience
Urol Clin North Am
Impact of supplemental external beam radiotherapy and/or androgen deprivation on biochemical outcome after permanent prostate brachytherapy
Int J Radiat Oncol Biol Phys
Intermediate term biochemical-free progression and local control following 125-Iodine brachytherapy for prostate cancer
J Urol
10-year disease-free survival rates after simultaneous irradiation for prostate cancer with a focus on calculation methodology
J Urol
Cited by (196)
Trimodality Therapy With Iodine-125 Brachytherapy, External Beam Radiation Therapy, and Short- or Long-Term Androgen Deprivation Therapy for High-Risk Localized Prostate Cancer: Results of a Multicenter, Randomized Phase 3 Trial (TRIP/TRIGU0907)
2024, International Journal of Radiation Oncology Biology PhysicsThe one hundred most cited publications in prostate brachytherapy
2021, BrachytherapyProstate Cancer
2019, Abeloff’s Clinical OncologyMulticenter Evaluation of Biochemical Relapse–Free Survival Outcomes for Intraoperatively Planned Prostate Brachytherapy Using an Automated Delivery System
2017, International Journal of Radiation Oncology Biology PhysicsCombination external beam radiation and brachytherapy boost for prostate cancer
2017, Cancer/Radiotherapie
Conflict of interest: none.