Treatment outcomes with permanent brachytherapy in high-risk prostate cancer patients stratified into prognostic categories.
OBJECTIVE
To determine whether a previously reported substratification system can be extrapolated to patients with high-risk prostate cancer treated with permanent interstitial brachytherapy.


METHODS
Four hundred six National Comprehensive Cancer Network patients with high-risk prostate cancer treated with permanent prostate brachytherapy with or without supplemental external beam radiotherapy were stratified into good (prostate-specific antigen >20 or Gleason score ≥8 or ≥T3), intermediate (prostate-specific antigen >20 and ≥T3), and poor (Gleason score ≥8 with ≥1 additional high-risk feature) prognostic cohorts. Because of only 1 patient with intermediate high-risk disease, the analysis was performed on patients in the good and poor cohorts. Biochemical failure (BF), prostate cancer-specific mortality (PCSM), distant metastasis, and overall mortality were assessed as function of prognostic group. Multiple parameters were evaluated for impact on outcome.


RESULTS
With a median followup time of 7.9 years, 10- and 14-year rates of BF and PCSM for the entire cohort were 7.8% and 3.7%, respectively. The BF rate was significantly greater in the poor prognostic category (16.8% vs. 7.8%, p = 0.041). The poor prognostic category was the strongest predictor of BF in univariate and multivariate analyses. No statistically significant differences in PCSM, distant metastasis, or overall mortality were identified between the good and poor prognostic categories.


CONCLUSIONS
Patients with high-risk prostate cancer treated with a brachytherapy approach have excellent long-term biochemical control and cancer-specific survival. The poor prognostic high-risk category had a higher rate of BF compared with the good prognostic category without a higher rate of PCSM or distant metastasis.
Department of Radiation Oncology, Tacoma/Valley Radiation Oncology Centers, Tacoma, WA.
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Bittner
Department of Radiation Oncology, Schiffler Cancer Center, Wheeling, WV; Department of Radiology, Wheeling Jesuit University, Wheeling, WV; Department of Urology, Wheeling Hospital, Wheeling, WV. Electronic address: gmerrick@urologicresearchinstitute.org.
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Merrick
Department of Radiation Oncology, Schiffler Cancer Center, Wheeling, WV; Department of Radiology, Wheeling Jesuit University, Wheeling, WV; Ohio University Eastern, St. Clairsville, OH.
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Galbreath
Department of Radiation Oncology, Schiffler Cancer Center, Wheeling, WV; Department of Radiology, Wheeling Jesuit University, Wheeling, WV.
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Butler
Department of Pathology, Wheeling Hospital, Wheeling, WV.
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E
Adamovich
D000368:Aged; D001918:Brachytherapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D012307:Risk Factors; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen
Brachytherapy; High risk; Overall mortality; Prognostic categories