Time to failure after definitive therapy for prostate cancer: implications for importance of aggressive local treatment.
OBJECTIVE
To explore patterns of time to failure in men receiving high doses of permanent seed brachytherapy with or without external beam radiation therapy as a function of risk status.


METHODS
Two thousand two hundred and thirty four patients were treated with prostate brachytherapy with median follow up of 8.0 years. The population was 35% low risk, 49% intermediate risk, and 16% high risk (NCCN). Median day 0 implant D90 was 119% and V100 was 98%. Treatment failure was defined as PSA > 0.40 ng/mL after nadir. Rates of biochemical failure, distant metastases, and prostate cancer death were determined with non-prostate death as a competing risk.


RESULTS
For all patients, the 10-year biochemical failure, distant metastases, and cause-specific mortality were 4.4%, 1.4%, and 1.3%, respectively. The biochemical failure rates were 1.3%, 4.8%, and 10.0% for men with low, intermediate, and high risk disease, respectively. Median time to failure was 2.8 years. In men who died from prostate cancer, the median time from treatment failure to death was 4.2 years. Overall, 83% of biochemical failures and 97% of metastases occurred within the first 4 years after treatment.


CONCLUSIONS
With the dose escalation achieved by high quality brachytherapy dosimetry, even high-risk prostate cancer patients have excellent long term biochemical outcomes. Treatment failures occur early, and one third become metastatic and progress rapidly to prostate cancer death. The low frequency and pattern of failures suggest the presence of micrometastatic disease prior to treatment is rare, even in high risk patients.
Dorothy Schneider Cancer Center, Mills-Peninsula Hospital, San Mateo.
Al V
AV
Taira
Schiffler Cancer Center & Wheeling Jesuit University, Wheeling.
Gregory S
GS
Merrick
Schiffler Cancer Center & Wheeling Jesuit University, Wheeling.
Wayne M
WM
Butler
Schiffler Cancer Center & Wheeling Jesuit University, Wheeling.
Robert W
RW
Galbreath
Schiffler Cancer Center & Wheeling Jesuit University, Wheeling.
Ryan
R
Fiano
Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle.
Kent E
KE
Wallner
Department of Pathology, Wheeling Hospital, Wheeling, USA.
Edward
E
Adamovich
biochemical survival; brachytherapy dose escalation; cause specific survival; metastases free survival; prostate cancer