Prostate-specific antigen relapse-free survival and side-effects in 734 patients with up to 10 years of follow-up with localized prostate cancer treated by permanent iodine implants.

Abstract

STUDY TYPE:

Therapy (case series) Level of Evidence 4.

OBJECTIVE:

To report our analysis of the oncological outcome, side-effects and complications after (125)I-brachytherapy, based on 10 years of experience, as low dose-rate (LDR) prostate brachytherapy is an accepted, effective and safe therapy for localized prostate cancer.

PATIENTS AND METHODS:

Between April 1999 and December 2006, 734 consecutive patients were treated with clinically localized prostate cancer with a follow-up of >or=30 months. No patients received external beam radiotherapy and 43% received hormonal therapy before brachytherapy; this therapy was given for 3-4 months. All patients had LDR prostate brachytherapy administered by one radiation oncologist. Biochemical failure was defined according to the 'Phoenix consensus'.

RESULTS:

The median follow-up for the 734 patients was 55 months; 26 had a clinical relapse and 11 died from prostate cancer; 20 patients died from other illnesses. The 10-year actuarial biochemical control was 92%, 84% and 65%, respectively (P < 0.001) for the low-, intermediate- and high-risk groups. Multivariate Cox regression analyses identified Gleason score and prostate-specific antigen (PSA) level as independent prognostic factors for biochemical failure. The actuarial biochemical control with Gleason score was 88%, 76% and 67% for patients with a Gleason score of <or=6, 7 and >7, respectively (P < 0.001). The biochemical control was 90%, 80% and 42% for patients with a PSA level of <or=10, 10.1-20 and >20 ng/mL, respectively (P < 0.001). No patients reported incontinence after treatment. There was acute urinary retention in 22 (2.9%) patients. Logistic regression showed that the most significant factors correlating with the probability of catheterization were the pretreatment prostate volume and hormonal therapy.

CONCLUSIONS:

The excellent long-term results and low morbidity, and the many advantages of prostate brachytherapy over other treatments, show that brachytherapy is an effective treatment for clinically organ-confined prostate cancer.

• Authors: Pedro J Prada, Germán Juan, Herminio González-Suárez, José Fernández, Isabel Jimenez, José Amón, Marcos Cepeda
• Journal: BJU international (BJU Int) Vol. 106 Issue 1 Pg. 32-6 (Jul 2010) ISSN: 1464-410X [Electronic] England
• PMID: 20067460 (Publication Type: Journal Article)

Chemical References

• Iodine Radioisotopes
• Prostate-Specific Antigen

Topics

• Adult
• Aged
• Aged, 80 and over
• Brachytherapy (adverse effects, methods)
• Epidemiologic Methods
• Humans
• Iodine Radioisotopes (therapeutic use)
• Male
• Middle Aged
• Prostate-Specific Antigen (metabolism)
• Prostatic Neoplasms (mortality, radiotherapy)
• Treatment Outcome