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| Title: | Intermediate-Risk
Localized Prostate Cancer in the PSA Era: Radiotherapeutic Alternatives |
| Author(s): | Vinai Gondi, Israel Deutsch, Mahesh Mansukhani,
Kathleen M. O’Toole, Jinesh N. Shah, Peter B. Schiff, Aaron
E. Katz, Mitchell C. Benson, Erik T. Goluboff, and Ronald D. Ennis |
| Lay Summary: | In this study, the authors evaluate various treatment techniques for a category of prostate cancer patients termed “intermediate risk.” These patients have moderately aggressive localized prostate cancer. The authors show that treatment that includes prostate brachytherapy has a superior outcome compared with standard external beam radiotherapy. The addition of hormone therapy to standard external beam radiotherapy also appears to improve the outcome of such patients. Brachytherapy based treatment, and hormone therapy combined with external beam radiotherapy appeared to give similar outcomes. |
| Objectives: | To retrospectively compare the biochemical disease-free
survival (BDFS) of patients treated with standard dose external
beam radiotherapy (SD-EBRT), SD-EBRT plus androgen deprivation (AD),
and brachytherapy-based treatment (brachytherapy with or without
EBRT with or without AD). |
| Methods: | All 297 patients with intermediate-risk prostate
cancer treated with these radiation-based treatments at our institution
from August 1989 to June 2001 were included. Biochemical relapse
was defined according to the American Society for Therapeutic Radiology
and Oncology (ASTRO) definition, a prostate-specific antigen level
of 1.5 ng/mL or greater and rising on two consecutive occasions
(the “Bolla” definition), and the current prostate-specific
antigen nadir plus 2 ng/mL with failure dated “at call”
(the “Houston/Phoenix” definition). The number of patients
treated with SD-EBRT, SD-EBRT plus AD, and brachytherapy-based treatment
was 141, 84, and 72, respectively. The year of treatment was analyzed
as a prognostic factor. The median follow-up was 32.3, 34.7, and
41.5 months for the ASTRO, Bolla, and Houston/Phoenix definitions,
respectively. |
| Results: | The brachytherapy-based treatment resulted in
improved BDFS compared with SD-EBRT (ASTRO definition, 5-year BDFS
rate 88% 5% versus 49% 5%, P 0.01; Bolla definition, 88% 8% versus
49% 5%, P 0.01; Houston/Phoenix definition, 81% 10% versus 64% 5%,
P 0.01). SD-EBRT plus AD was superior to SD-EBRT alone using the
Bolla definition (5-year BDFS 76% 7% versus 49% 5%, P 0.01) and
the Houston/Phoenix definition (85% 6% versus 64% 5%, P 0.01), but
not using the ASTRO definition (P 0.17). Multivariate analysis,
including prostate-specific antigen, clinical stage, Gleason score,
and year of treatment, demonstrated improved biochemical outcomes
for brachytherapy-based treatment versus SD-EBRT (ASTRO, P 0.01;
Bolla, P 0.01; and a trend toward significance with Houston/Phoenix,
P 0.07) and for the addition of AD to SD-EBRT (Bolla, P 0.01 and
Houston/Phoenix, P 0.03). The year of treatment trended toward significance
(P 0.077) on multivariate analysis using the ASTRO definition. |
| Conclusion: | For patients with intermediate-risk prostate cancer, brachytherapy-based treatment and the addition of AD to SD-EBRT resulted in improved biochemical outcomes compared with the outcomes with SD-EBRT alone; however, these findings were dependent on the definition of biochemical failure used. The year of treatment may be an important prognostic factor in intermediate-risk prostate cancer. UROLOGY 69: 541–546, 2007. |
Copyright © 2006