Permanent interstitial brachytherapy in younger patients with clinically organ-confined prostate cancer.
OBJECTIVE
To evaluate biochemical progression-free survival in hormone-naive men 62 years of age or younger with clinically organ-confined prostate cancer who underwent brachytherapy with or without supplemental external beam radiotherapy.


METHODS
From April 1995 through December 2000, 119 hormone-naive patients 62 years of age or younger underwent permanent interstitial brachytherapy for clinical T1b-T2cNxM0 (2002 American Joint Committee on Cancer) prostate cancer. No patient underwent seminal vesicle biopsy or pathologic lymph node staging. The median follow-up was 5.4 years. Biochemical progression-free survival was defined by either a prostate-specific antigen (PSA) level of 0.4 ng/mL or less after a nadir or by the American Society for Therapeutic Radiology and Oncology consensus definition. No patient was lost to follow-up. The clinical, treatment, and dosimetric parameters evaluated for biochemical progression-free survival included age, clinical T stage, Gleason score, pretreatment PSA level, risk group, percentage of positive biopsies, isotope, supplemental external beam radiotherapy, prostate volume, brachytherapy planning volume, percentage of the target volume receiving 100%, 150%, and 200% of the prescribed dose, minimal percentage of the prescribed dose covering 90% of the target volume, and tobacco status.


RESULTS
For the entire group, the actuarial 7-year biochemical progression-free survival rate was 96.1% and 98.3% for a PSA cutpoint of 0.4 ng/mL or less and for the American Society for Therapeutic Radiology and Oncology consensus definition, respectively. Using a PSA biochemical control definition of 0.4 ng/mL or less, 93.1%, 100%, and 95.2% of the low-risk, intermediate-risk, and high-risk hormone-naive patients were free of biochemical progression. The median post-treatment PSA level for the biochemically disease-free group was less than 0.1 ng/mL. In multivariate analysis, only the pretreatment PSA level predicted the biochemical outcome.


CONCLUSIONS
Hormone-naive patients 62 years of age or younger have a high probability of 7-year biochemical progression-free survival after permanent interstitial brachytherapy with or without supplemental external beam radiotherapy.
Merrick
Gregory S
GS
Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia 26003-6300, USA.
Butler
Wayne M
WM
Wallner
Kent E
KE
Galbreath
Robert W
RW
Adamovich
Edward
E
D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D001918:Brachytherapy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010165:Palladium / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D020266:Radiotherapy, Conformal; D011882:Radiotherapy, High-Energy; D012306:Risk; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium