Brachytherapy in men aged ≤ 54 years with clinically localized prostate cancer

• Published in: BJU international 2006-08, Vol.98 (2), p.324-328
• Main Authors: MERRICK, GREGORY S., WALLNER, KENT E., BUTLER, WAYNE M., GALBREATH, ROBERT W., ALLEN, ZACHARIAH A., ADAMOVICH, EDWARD, TRUE, LAWRENCE
• Format: Article
• Language: English
• Subjects: age; Biological and medical sciences; brachytherapy; Brachytherapy - methods; Disease-Free Survival; Genital system. Mammary gland; Humans; Iodine Radioisotopes - therapeutic use; Isotopes - therapeutic use; I‐125; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Palladium - therapeutic use; Pd‐103; prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - radiotherapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2006.06248.x

OBJECTIVE To report the biochemical progression‐free survival (BPFS) in hormone‐naive men aged ≤ 54 years who underwent brachytherapy with or without supplemental external beam radiation therapy (EBRT), as despite favourable biochemical control rates with brachytherapy, there remains a reluctance to recommend non‐extirpative approaches for young men with clinically localized prostate cancer. PATIENTS AND METHODS From April 1995 to October 2002, 108 hormone‐naive patients aged ≤ 54 years (median 52 years, range 45–54) had permanent interstitial brachytherapy for clinical stage T1c‐T2c NXM0 (2002 American Joint Committee on Cancer staging) prostate cancer. No patient had a seminal vesicle biopsy or pathological lymph node staging. The mean (sd, median) follow‐up was 5.3 (1.8, 4.8) years. BPFS was defined by a prostate‐specific antigen (PSA) level of ≤ 0.40 ng/mL after the nadir. Risk groups were assigned using the Memorial Sloan‐Kettering Cancer Center criteria. Several clinical, treatment and dosimetric variables were evaluated for their effect on BPFS. RESULTS For the entire group, the actuarial 8‐year BPFS was 96%; for low‐ (57 men), intermediate‐ (47) and high‐ (four) risk patients, the BPFS rates were 96%, 100% and three of four, respectively. For biochemically disease‐free patients, the median PSA level after treatment was 0.05 ng/mL. In a multivariate analysis, only pretreatment PSA level predicted biochemical control, while dosimetry variables after treatment were almost statistically significant. CONCLUSIONS Hormone‐naive patients aged ≤ 54 years have a high probability of a good 8‐year BPFS after permanent interstitial brachytherapy with or without supplemental EBRT.