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Excellent Long-Term Outcomes with Prostate Brachytherapy in Young Men Less Than 55 Years Old

      Purpose

      Controversy exists as to the biological behavior of prostate cancer in younger patients and consequently to their optimal treatment. Some physicians have advocated a primary surgical approach in young patients. The purpose of this study was to evaluate the long-term outcomes of low-dose-rate (LDR) prostate brachytherapy based treatment in this younger cohort of patients.

      Materials and Methods

      Four thousand men have undergone prostate seed implantation at our institution since July 1997. All patients are followed prospectively in our IRB-approved database and assessed for clinical and biochemical recurrence based on the Phoenix definition. Risk stratification was assigned per NCCN guidelines. Patients with initial PSA >50 were not included in this analysis. This analysis reviews 170 consecutive patients treated at ages ≤55 years old. Twenty-two percent of patients were treated with LDR Iodine-125 seed implant monotherapy, and 78% Palladium-103 seed implant combined with 45 Gray external radiation. Seed implants were performed using a dynamic intraoperative dosimetry technique. Combination therapy was primarily employed in intermediate- and high-risk groups. Sixty percent of patients received short course hormone therapy for a median duration of 6 months.

      Results

      With a median followup of 80 months, 94% of all patients were free from biochemical failure (FFBF). On subset analysis, 98% of low-risk, 95% of intermediate-risk, and 84% of high-risk patients were FFBF. Grade 3 complications occurred in only 2.9% of patients. These consisted mostly of urinary retention and its subsequent management. No grade 4 complications occurred.

      Conclusions

      Prostate seed implant based treatments resulted in excellent long-term outcomes with minimal morbidity in this young cohort of patients. These results compared favorably to surgical and other series.