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Keywords:

  • prostate cancer;
  • Gleason score 8–10;
  • brachytherapy;
  • external beam radiotherapy;
  • hormonal therapy

OBJECTIVE

To assess the outcomes for patients with Gleason score 8–10 prostate cancer treated with brachytherapy, external beam radiotherapy (EBRT) and hormonal therapy (HT).

PATIENTS AND METHODS

In all, 181 patients with Gleason scores 8–10 prostate cancer were treated from 1994 to 2006 with a 103Pd implant (prescription dose 100 Gy), 45 Gy of EBRT and 9 months of HT. The median (range) follow-up was 65 (24–150) months; freedom from biochemical failure (FBF) rates were calculated using the Phoenix definition.

RESULTS

The 8-year actuarial FBF, freedom from distant metastases, prostate-cancer specific survival and overall survival were 73%, 80%, 87% and 79%, respectively. The pretreatment prostate-specific antigen (PSA) level significantly affected FBF, with 8-year rates of 72%, 82% and 58% for patients with PSA level of ≤10, >10–20 and >20 ng/mL, respectively (P = 0.006). The PSA level had no significant effect on rates of distant metastases. The Gleason score had the most significant affect on FBF in a multivariate analysis, and was the only factor to significantly affect rates of distant metastases; the 8-year FBF rates were 84%, 55% and 30% for scores of 8, 9 and 10, respectively (P = 0.003). The corresponding freedom from distant metastases and prostate-cancer specific survival rates were 86%, 76%, 30% (P < 0.001) and 92%, 80%, 62.5% (P = 0.003), respectively.

CONCLUSIONS

The 8-year outcomes after this regimen showed favourable biochemical and distant control, as well disease-specific survival rates for patients with Gleason scores of 8–10. This treatment approach should be considered as a viable option for this subset of patients with high-risk disease.