Abstract
Purpose
To report the biochemical control rate and clinical outcomes with real-time inverse
planning (inverse optimization prostate seed implant [IO-PSI]) for favorable-risk
(FR) and intermediate-risk (IR) prostate adenocarcinoma in a community practice setting.
This analysis is an extended followup of our initial report, with favorable early
biochemical control rate (biochemical nonevidence of disease) of 97% at 4 years.
Methods and Materials
Three hundred fifty-seven evaluable patients with FR and IR prostate cancer underwent
real-time IO-PSI (iodine-125/145 Gy or palladium-103/120 Gy) between 2001 and 2013.
Results
With a median followup of 54 months (range, 24–110 months), the absolute biochemical
failure free survival of disease was 96%. The 8-year actuarial probability of prostate-specific
antigen failure-free survival for FR and IR cohorts was 92.4% and 87%, respectively.
Late genitourinary and gastrointestinal toxicity remained low. Late Grade 2 and Grade
3 genitourinary toxicity was 19% and 1%, respectively. Late Grade 2 and 3 rectal bleeding
rates were 1% and 0%, respectively. No difference in biochemical control was observed
with preimplant short course androgen deprivation or between Gleason score 3 + 4 vs.
4 + 3 patients. No dosimetric parameter was predictive of biochemical failure. Patients
with FR had a significantly decreased risk of failure (hazard ratio = 0.26; 95% confidence
interval = 0.09–0.78; p = 0.02) compared with those with IR. Patients with a prostate-specific antigen nadir
>0.4 ng/mL had an increased risk of failure (hazard ratio = 1.37; 95% confidence interval =
1.27–1.47; p < 0.0001).
Conclusions
Our initial biochemical and clinical outcomes using real-time IO-PSI persisted with
extended followup and support our original hypothesis for use of a reduced number
of sources, needles, and total activity, suggesting that with IO, less is more.
Keywords
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Article Info
Publication History
Published online: February 07, 2017
Accepted:
December 30,
2016
Received in revised form:
December 30,
2016
Received:
October 26,
2016
Identification
Copyright
© 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
