Advertisement

Permanent prostate brachytherapy monotherapy with I-125 for low- and intermediate-risk prostate cancer: Outcomes in 974 patients

Published:October 04, 2018DOI:https://doi.org/10.1016/j.brachy.2018.09.003

      Abstract

      Purpose

      To report outcomes of patients undergoing low-dose-rate (LDR) brachytherapy and investigate factors associated with biochemical failure and survival.

      Methods

      Consecutive patients undergoing LDR with I-125 at our institution between 1998 through 2013 for primary intact prostate cancer were examined. Those with low- and intermediate-risk disease receiving LDR with a minimum of 2 years followup and at least one post-LDR prostate-specific antigen (PSA) were included.

      Results

      About 974 patients satisfied inclusion criteria. With median followup of 72 months, biochemical failure occurred in 45 patients. Freedom from biochemical failure as defined by the Phoenix criterion was 96% and 88% at 5 and 10 years, worse for intermediate risk as compared with low risk, with 10-year freedom from biochemical failure of 76% versus 92% (hazard ratio [HR] = 3.7, p < 0.001), respectively. On multivariable analysis, increased prebiopsy PSA, Gleason 4 + 3, and no androgen deprivation therapy were associated with biochemical failure. Gleason 4 + 3 was the factor most strongly associated with biochemical failure (HR = 7.01, p < 0.001). No examined factors were associated with local failure. Gleason 4 + 3 disease increased the likelihood of distant metastasis (HR = 12.4, p = 0.003) and prostate cancer–specific death (HR = 13.2, p < 0.001). No difference in outcomes between patients with Gleason 3 + 3 versus 3 + 4 was observed.

      Conclusions

      LDR brachytherapy provided excellent outcomes in this large series of patients treated for localized organ-confined prostate cancer. Local recurrence at 10 years was low at 2.1%. Primary Gleason 4 + 3, higher pretreatment PSA, and no receipt of androgen deprivation therapy were the only factors associated with biochemical failure. Primary Gleason 4 disease was also predictive of distant metastases and decreased prostate cancer–specific survival.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Brachytherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2016.
        CA Cancer J Clin. 2016; 66: 7-30
      1. National comprehensive cancer Network.
        (Available at:)
        • Blasko J.C.
        • Grimm P.D.
        • Sylvester J.E.
        • et al.
        Palladium-103 brachytherapy for prostate carcinoma.
        Int J Radiat Oncol Biol Phys. 2000; 46: 839-850
        • Crook J.
        • Borg J.
        • Evans A.
        • et al.
        10-year experience with I-125 prostate brachytherapy at the Princess Margaret Hospital: results for 1100 patients.
        Int J Radiat Oncol Biol Phys. 2011; 80: 1323-1329
        • Fellin G.
        • Mirri M.A.
        • Santoro L.
        • et al.
        Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions.
        Br J Radiol. 2016; 89: 20150981
        • Kittel J.A.
        • Reddy C.A.
        • Smith K.L.
        • et al.
        Long-term efficacy and toxicity of low-dose-rate (1)(2)(5)I prostate brachytherapy as monotherapy in low-, intermediate-, and high-risk prostate cancer.
        Int J Radiat Oncol Biol Phys. 2015; 92: 884-893
        • Zelefsky M.J.
        • Kuban D.A.
        • Levy L.B.
        • et al.
        Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation.
        Int J Radiat Oncol Biol Phys. 2007; 67: 327-333
        • Shah C.
        • Lanni Jr, T.B.
        • Ghilezan M.I.
        • et al.
        Brachytherapy provides comparable outcomes and improved cost-effectiveness in the treatment of low/intermediate prostate cancer.
        Brachytherapy. 2012; 11: 441-445
        • Han K.
        • Milosevic M.
        • Fyles A.
        • et al.
        Trends in the utilization of brachytherapy in cervical cancer in the United States.
        Int J Radiat Oncol Biol Phys. 2013; 87: 111-119
        • Martin J.M.
        • Handorf E.A.
        • Kutikov A.
        • et al.
        The rise and fall of prostate brachytherapy: use of brachytherapy for the treatment of localized prostate cancer in the National Cancer Data Base.
        Cancer. 2014; 120: 2114-2121
        • Orio 3rd, P.F.
        • Nguyen P.L.
        • Buzurovic I.
        • et al.
        The decreased use of brachytherapy boost for intermediate and high-risk prostate cancer despite evidence supporting its effectiveness.
        Brachytherapy. 2016; 15: 701-706
        • Hassan O.
        • Han M.
        • Zhou A.
        • et al.
        Incidence of extra-prostatic extension at radical prostatectomy with pure Gleason score 3+3=6 (grade group 1) cancer: implications for whether Gleason score 6 prostate cancer should be renamed as “not cancer” and for selection criteria for active surveillance.
        J Urol. 2017; 199: 1482-1487
        • Pugh T.J.
        • Frank S.J.
        • Achim M.
        • et al.
        Prediction of extraprostatic extension in intermediate risk prostate cancer: the evolving role of endorectal MRI.
        Int J Radiat Oncol Biol Phys. 2011; 81: S398
        • Davis B.J.
        • Taira A.V.
        • Nguyen P.L.
        • et al.
        ACR appropriateness criteria: permanent source brachytherapy for prostate cancer.
        Brachytherapy. 2017; 16: 266-276
        • Davis B.J.
        • Horwitz E.M.
        • Lee W.R.
        • et al.
        American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy.
        Brachytherapy. 2012; 11: 6-19
        • Nag S.
        • Beyer D.
        • Friedland J.
        • et al.
        American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer.
        Int J Radiat Oncol Biol Phys. 1999; 44: 789-799
        • Stock R.G.
        • Stone N.N.
        • Tabert A.
        • et al.
        A dose-response study for I-125 prostate implants.
        Int J Radiat Oncol Biol Phys. 1998; 41: 101-108
        • Pisansky T.M.
        • Blute M.L.
        • Hillman D.W.
        • et al.
        The relevance of prostatectomy findings for brachytherapy selection in patients with localized prostate carcinoma.
        Cancer. 2002; 95: 513-519
        • Sengupta S.
        • Davis B.J.
        • Mynderse L.A.
        • et al.
        Permanent prostate brachytherapy: pathologic implications as assessed on radical prostatectomy specimens of broadening selection criteria for monotherapy.
        Urology. 2006; 68: 810-814
        • Roach 3rd, M.
        • Hanks G.
        • Thames Jr, H.
        • et al.
        Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference.
        Int J Radiat Oncol Biol Phys. 2006; 65: 965-974
        • Stish B.J.
        • Davis B.J.
        • Mynderse L.A.
        • et al.
        Low dose rate prostate brachytherapy.
        Transl Androl Urol. 2018; 7: 341-356
        • Marshall R.A.
        • Buckstein M.
        • Stone N.N.
        • et al.
        Treatment outcomes and morbidity following definitive brachytherapy with or without external beam radiation for the treatment of localized prostate cancer: 20-year experience at Mount Sinai Medical Center.
        Urol Oncol. 2014; 32: 38.e1-38.e7
        • Taira A.V.
        • Merrick G.S.
        • Butler W.M.
        • et al.
        Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy.
        Int J Radiat Oncol Biol Phys. 2011; 79: 1336-1342
        • Zumsteg Z.S.
        • Spratt D.E.
        • Pei I.
        • et al.
        A new risk classification system for therapeutic decision making with intermediate-risk prostate cancer patients undergoing dose-escalated external-beam radiation therapy.
        Eur Urol. 2013; 64: 895-902
        • Epstein J.I.
        • Zelefsky M.J.
        • Sjoberg D.D.
        • et al.
        A contemporary prostate cancer grading system: a validated alternative to the Gleason score.
        Eur Urol. 2016; 69: 428-435
        • Potters L.
        • Huang D.
        • Calugaru E.
        • et al.
        Importance of implant dosimetry for patients undergoing prostate brachytherapy.
        Urology. 2003; 62: 1073-1077
        • Lawton C.A.
        • DeSilvio M.
        • Lee W.R.
        • et al.
        Results of a phase II trial of transrectal ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (radiation therapy oncology group 98-05).
        Int J Radiat Oncol Biol Phys. 2007; 67: 39-47
        • Lee W.R.
        • Bae K.
        • Lawton C.
        • et al.
        Late toxicity and biochemical recurrence after external-beam radiotherapy combined with permanent-source prostate brachytherapy: analysis of Radiation Therapy Oncology Group study 0019.
        Cancer. 2007; 109: 1506-1512
        • Prestidge B.R.
        • Winter K.
        • Sanda M.G.
        • et al.
        Initial report of NRG oncology/RTOG 0232: a phase 3 study comparing combined external beam radiation and transperineal interstitial permanent brachytherapy with brachytherapy alone for selected patients with intermediate-risk prostatic carcinoma.
        Int J Radiat Oncol Biol Phys. 2016; 96: S4