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

Authors


Gregory S. Merrick, Schiffler Cancer Center, Wheeling Hospital, 1 Medical Park, Wheeling, WV 26003–6300, USA. e-mail: gmerrick@urologicresearchinstitute.org

Abstract

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.

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