103Pd brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma.

Abstract

PURPOSE:

To summarize biochemical failure rates and morbidity of external beam irradiation (EBRT) combined with palladium (103Pd) boost for clinically localized high-risk prostate carcinoma.

METHODS AND MATERIALS:

Seventy-three consecutive patients with stage T2a-T3 prostatic carcinoma were treated from 1991 through 1994. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (71 patients), Gleason score 7-10 (40 patients), prostate specific antigen (PSA) > 15 (32 patients), or elevated prostatic acid phosphatase (PAP) (17 patients). Patients received 41 Gy EBRT to a limited pelvic field, followed 4 weeks later by a 103Pd boost (prescription dose: 80 Gy). Biochemical failure was defined as a PSA greater than 1.0 ng/ml (normal < 4.0 ng/ml). Patients whose PSA was still decreasing at the last follow-up were censored at that time. Patients whose PSA plateaued at a value greater than 1.0 were scored as failures at the time the PSA first plateaued.

RESULTS:

The overall, actuarial freedom from biochemical failure at 3 years after treatment was 79%. In Cox proportional hazard multivariate analysis, the strongest predictor of failure was elevated acid phosphatase (p = 0.04), followed by PSA (p = 0.17), Stage (p = 0.23), and Gleason score (p = 0.6). Treatment-related morbidity was usually limited to temporary, RTOG Grade 1-2 urinary symptoms. One patient, who had both a transurethral incision of the prostate (TUIP) and a transurethral resection of the prostate (TURP), developed low-volume urinary incontinence. The actuarial potency rate at 3 years after implantation was 77% for 46 patients who were sexually potent prior to implant.

CONCLUSION:

Biochemical freedom from failure rates following combined EBRT and 103Pd brachytherapy for clinically localized, high-risk prostate cancer compare favorably with that reported after conventional dose EBRT alone. Morbidity has been acceptable.

• Authors: M Dattoli, K Wallner, R Sorace, J Koval, J Cash, R Acosta, C Brown, J Etheridge, M Binder, R Brunelle, N Kirwan, S Sanchez, D Stein, S Wasserman
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 35 Issue 5 Pg. 875-9 (Jul 15 1996) ISSN: 0360-3016 [Print] United States
• PMID: 8751395 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• Radioisotopes
• Palladium
• Prostate-Specific Antigen

Topics

• Aged
• Aged, 80 and over
• Biomarkers, Tumor (blood)
• Brachytherapy
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Palladium (therapeutic use)
• Penile Erection (radiation effects)
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms (blood, pathology, radiotherapy)
• Radioisotopes (therapeutic use)