ABSTRACT
PURPOSE
To compare biochemical recurrence free survival (BCRFS) and cancer-specific survival
(CSS) after brachytherapy using the AUA and the Phoenix definitions.
METHODS AND MATERIALS
2634 men with T1-T4N0M0 prostate cancer were treated with brachytherapy with or without
neoadjuvant hormonal therapy or external beam radiation therapy. Five, 10, and 15-
year BCRFS and CSS were estimated with Kaplan-Meier estimates with log rank. Multivariate
analysis of survival was performed with Cox regression analysis.
RESULTS
Median age was 66, follow-up was 8.6 years, and prostate specific antigen was 6.9.
Overall, 11.1% (n = 293) of patients experienced Phoenix BCR and 17.48% (n = 457) experienced AUA BCR. The rates of AUA BCR and Phoenix BCR were significantly
different at 5 and 10-years but not at 15 years. Patients treated with BED ≤ 200 Gy
were more likely to experience AUA BCR (22.5% vs. 12.4%, OR 1.44, p < 0.001) and Phoenix BCR (14.3% and 8.3%, OR 1.37, p < 0.001) than patients treated with a BED > 200 Gy.
CONCLUSIONS
Compared to the Phoenix definition, the AUA definition of BCR after brachytherapy
is associated with significantly worse BCRFS for the first 15 years after treatment.
Receiving a BED > 200, which cannot be achieved without the addition of brachytherapy,
is associated with better BCRFS and CSS. Our findings reaffirm the importance of dose
in the management of prostate cancer
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 accessOne-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 BrachytherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer: a systematic review.Eur Urol. 2019; 75: 967-987
- Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition.J Clin Oncol. 2006; 24: 3973-3978
- Clinically Localized Prostate Cancer: AUA /ASTRO / SUO Guideline.American Urological Association, 2017
- 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
- Comparison of tumor control and toxicity outcomes of high-dose intensity-modulated radiotherapy and brachytherapy for patients with favorable risk prostate cancer.Urology. 2011; 77: 986-990
- Long-term biochemical control and cause-specific survival in men with Gleason grade Group 4 and 5 prostate cancer treated with brachytherapy and external beam irradiation.Brachytherapy. 2020; 19: 275-281
- Long-term prostate specific antigen stability and predictive factors of failure after permanent seed prostate brachytherapy.J Urol. 2018; 199: 120-125
- A modified technique allowing interactive ultrasound-guided three-dimensional transperineal prostate implantation.Int J Radiat Oncol Biol Phys. 1995; 32: 219-225
- In traoperative dosimetric representation of the real-time ultrasound- guided prostate implant.Tech Urol. 2000; 6: 95-98
- Biologically effective dose values for prostate brachytherapy: effects on PSA failure and posttreatment biopsy results.Int J Radiat Oncol Biol Phys. 2006; 64: 527-533
- Outcomes for patients with high-grade prostate cancer treated with a combination of brachytherapy, external beam radiotherapy and hormonal therapy.BJU Int. 2009; 104: 1631-1636
- Multicenter analysis of effect of high biologic effective dose on biochemical failure and survival outcomes in patients with Gleason score 7-10 prostate cancer treated with permanent prostate brachytherapy.Int J Radiat Oncol Biol Phys. 2009; 73: 341-346
- A critical analysis of the interpretation of biochemical failure in surgically treated patients using the American society for therapeutic radiation and oncology criteria.J Urol. 2002; 168: 1419-1422
- Is it possible to compare PSA recurrence-free survival after surgery and radiotherapy using revised ASTRO criterion-"Nadir + 2"?.Urology. 2008; 72: 389-393
- A standard definition of disease freedom is needed for prostate cancer: undetectable prostate specific antigen compared with the American society of therapeutic radiology and oncology consensus definition.J Urol. 2002; 167: 1310-1313
- Using a surgical prostate-specific antigen threshold of >0.2 ng/mL to define biochemical failure for intermediate- and high-risk prostate cancer patients treated with definitive radiation therapy in the ASCENDE-RT randomized control trial.Brachytherapy. 2018; 17: 837-844
- Comparison of outcome endpoints in intermediate- and high-risk prostate cancer after combined-modality radiotherapy.Brachytherapy. 2020; 19: 24-32
- 25-year disease-free survival rate after irradiation for prostate cancer calculated with the prostate specific antigen definition of recurrence used for radical prostatectomy.J Urol. 2013; 189: 878-883
- A biochemical definition of cure after brachytherapy for prostate cancer.Radiother Oncol. 2020; 149: 64-69
- PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis.Int J Radiat Oncol Biol Phys. 2006; 64: 1140-1150
- What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation.Radiother Oncol. 2015; 115: 295-300
Article Info
Publication History
Published online: July 25, 2022
Accepted:
May 5,
2022
Received in revised form:
April 4,
2022
Received:
October 4,
2021
Publication stage
In Press Corrected ProofFootnotes
Disclosures: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Identification
Copyright
© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
