LONG-TERM OUTCOMES OF BRACHYTHERAPY TREATMENT

Up to 12 years after treatment, brachytherapy produces long-term survival rates similar to radical prostatectomy and external beam radiation therapy.

Twelve-Year Outcomes Following Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer, Louis Potters, MD, FACR, Carol Morgenstern, RN, Emil Calugaru, MS, Paul Fearn, BS, Anup Jassal, BA, Joseph Presser, MS, and Edward Mullen, MD. Journal of Urology, 2005;May;173:1562-1566.

Type of Study Identified patient outcomes 12 years following treatment of localized prostate cancer with permanent prostate brachytherapy.
Purpose To assess long-term outcomes of men treated with “seed therapy.”.
Issues
How effective is brachytherapy?
How does brachytherapy compare to other prostate cancer treatments?
What are the implications of using brachytherapy alone or in combination with other treatments?
Number of Patients 1,449
Type of Patients
Average age of 68.
Average PSA of 10.1.
55% with Gleason scores of 6; 28% with Gleason scores of 7.
27% also received hormone therapy.
20% also received external beam radiation therapy.
Length of Time Patients Were Followed The study assessed patient outcomes up to 12 years following treatment.
Notes Researchers assessed outcomes using several definitions of biochemical freedom from recurrence including ASTRO, ASTRO-Kattan, ASTRO-Last Call and Houston.
Results and/or Conclusions
Overall survival rate 12 years following treatment was 81%. However, some patients died from other causes, resulting in a disease-specific survival rate of 93%.
Biochemical control rates of patients receiving this treatment appear similar to those of patients treated with radical prostatectomy or external beam radiation.
The value of combining brachytherapy with additional treatments, such as external beam radiation or hormone therapy, remains questionable.

“Permanent prostate brachytherapy has emerged as a definitive treatment option for men with clinically localized prostate cancer,” according to the study. Because the technique was perfected in the late 1980s and early 1990s, long-term data is now becoming available. This research was devised to review outcomes of men undergoing brachytherapy treatment as long as 12 years ago.

Researchers examined long-term outcomes of 1,449 men with localized prostate cancer treated with brachytherapy. Those considered low risk (PSA values of less than 10, Gleason scores of 2 to 6 and staged at T1-T2a) were treated with brachytherapy alone. Patients with PSAs greater than 10, Gleason scores of 7 to 10 or staged at T2b were offered a combination of brachytherapy and external beam radiation therapy. Altogether, some 20% also received external beam radiation therapy and 27% received hormone therapy in addition to brachytherapy.

The study reported the following conclusions:

Overall survival rate 12 years following treatment was 81%. However, some patients died from other causes, resulting in a disease-specific survival rate of 93%.
Twelve-year biochemical freedom from recurrence was 81% (according to the ASTRO definition), 78% (according to ASTRO-Kattan), 74% (according to ASTRO-Last Call) and 77% (according to Houston).
Biochemical control rates of patients receiving this treatment appear similar to those of patients treated with radical prostatectomy or external beam radiation.
The value of combining brachytherapy with additional treatments, such as external beam radiation or hormone therapy, remains questionable, pending further study. “While combining EBRT (external beam radiation therapy) and brachytherapy remains a popular method for treating some patients, the current study does not support the effectiveness of EBRT for predicting BFR (biochemical freedom from recurrence)… Likewise the role of AA (androgen ablation – also known as hormone therapy) therapy remains controversial.” Typically, this treatment is used to reduce prostate size prior to brachytherapy. “However, this approach may carry the unfortunate risk of higher urinary retention rates.” The authors conclude that prostate size reduction may be unnecessary since data indicates that brachytherapy can still be effectively performed when this condition is present.

“This study presents 12-year outcomes from a maturing data set of consecutively treated patients who have undergone ultrasound-guided, transperineal prostate brachytherapy,” the researchers state. “Regardless of the definition used, biochemical control continues to support brachytherapy as a successful treatment option in men presenting with clinically localized prostate cancer. Our results are similar to those of others who have presented 8- to 13-year biochemical control rates between 66% and 88%.”

NOTE FROM THERAGENICS®: Of 1,283 submissions, this research was one of two abstracts selected for presentation at the 2004 American Society for Therapeutic Radiology and Oncology (ASTRO) meeting. Of 1,449 patients involved in the study, 1,129 were treated with the TheraSeed® device.

Principal Investigator: Louis Potters, M.D., FACR, New York Prostate Institute at South Nassau Communities Hospital, Oceanside, N.Y.