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Twelve year outcomes following permanent brachytherapy in patients with clinically localized prostate cancer

2004; Elsevier BV; Volume: 60; Issue: 1 Linguagem: Inglês

10.1016/j.ijrobp.2004.06.114

1879-355X

Louis Potters, C. Morgenstern, E.E. Mullen, Paul Fearn, Arun Jassal, Michael W. Kattan,

Hormonal and reproductive studies

To review the outcomes in men treated with permanent prostate brachytherapy (PPB). The study cohort includes 1504 consecutive patients treated with PPB between 1992 and 2000. All patients were treated with permanent low-dose rate I–125 or Pd–103, either as monotherapy or with external radiation. All patients were clinically staged and all pathology underwent a second view. The majority of patients presented with Gleason 6 tumors (55%) with 28% having Gleason 7 disease. The mean age was 68, with a mean pretreatment PSA of 10.1 (.4–112). Four hundred–eight patients (27%) were treated with adjuvant or neoadjuvant hormones (mean duration 3.7 months, range 2–7). Three hundred–five (20%) were treated with combination external radiation plus PPB. Biochemical failure was determined by the ASTRO (BCR–ASTRO) definition modified for early censoring and the Houston definition (BCR–Houston)(PSA rise ≥2ng/ml from baseline). Statistical analysis consisted of Cox regression analysis to assess risk for BCR. The median follow–up was 61 months with 32 patients at risk at 144 months. Overall and disease specific survival at 12 years is 84% and 93%, respectively. BCR using the ASTRO and Houston definitions are 78% and 76%, respectively. BCR–ASTRO by risk stratification (Zelefsky classification) was 84% for low risk patients, 78% for intermediate risk patients and 68% for high risk patients (p = .0001). Cox regression identified that pretreatment PSA (.0001), Gleason score (.0001) and the D90 dose (.004) were significant to predict BCR–ASTRO, while clinical stage (.422), the addition of hormones (.874), the addition of external radiation (.095) and isotope selection (.218) were insignificant factors predicting BCR-ASTRO. Analysis of BCR–ASTRO patients identified disease–specific survival of 65% with a PSA doubling time of less than 12 months versus 92% with a PSA doubling time ≥12 months (p = .0001). This is one of the largest series reporting 12-year outcomes following PPB. BCR outcomes can be predicted by a patients pretreatment PSA values and Gleason score; therefore risk-stratification by these clinical factors statistically segregates outcomes. Nonetheless, implant dosimetry continues to predict for BCR. The addition of adjuvant therapies such as hormones and external radiation do not predict for BCR, yet this was not prospectively controlled. In patients with biochemical failure, it appears that the PSA doubling time of less than 12 months is an important predictor for survival. This may encourage more aggressive salvage treatment in those patients