Pd-103 LONG-TERM RESULTS

Nine years following TheraSeed® treatment, 83.5% of patients with a broad spectrum of Gleason scores were free of prostate cancer.

Palladium-103 Brachytherapy for Prostate Carcinoma, John C. Blasko, MD, Peter D. Grimm, DO, John E. Sylvester, MD, Kas Ray Badiozamani, MD, David Hoak, MD, and William Cavanagh, BS. International Journal of Radiation Oncology Biology – Physics, 2000;46(4):839-850.

Type of Study Examined the long-term effectiveness of palladium-103 brachytherapy treatment as a single treatment for prostate cancer.
Purpose To review biochemical outcomes (cure rates) for patients treated only with palladium-103 (using the TheraSeed® device) brachytherapy over a fixed time interval.
Issues
How effective is brachytherapy with Pd-103?
Is Pd-103 effective as the only treatment for patients encompassing a broad spectrum of Gleason scores?
Number of Patients 230
Type of Patients
Stage T1-T2 prostate cancer (according to 1992 American Joint Committee of Cancer criteria).
Gleason scores ranged from 3-10.
PSA levels ranged from .2-94.
Length of Time Patients Were Followed Up to nine years.
Notes Biochemical failure was defined as two consecutive rises in serum PSA.
Results and/or Conclusions
“These outcomes demonstrate a high rate of biochemical and clinical tumor control to 9 years.”
“The overall biochemical control rate achieved at 9 years was 83.5%. Significant risk factors contributing to failure were serum PSA greater than 10…and Gleason sum of 7 or greater. Five-year biochemical control for those exhibiting neither risk factor was 94%; one risk factor 82%; both risk factors 65%.”
No patients died from prostate cancer.
Prostate brachytherapy with Pd-103 achieves a high rate of biochemical and clinical control across a broad spectrum of patients with clinically organ-confined disease.

Participants in this study included 230 patients with localized prostate cancer who experienced brachytherapy with palladium-103 (using the TheraSeed® device) as their sole form of treatment. The study included all such patients treated at The Seattle Prostate Institute from January 1988 through December 1995. Patients exhibited a variety of cancer stages and characteristics including:

40% classified as poorly differentiated with Gleason sum scores of 7 or greater.
56% with palpable T2a disease.
PSAs up to 30 and beyond, with 63.5% in the 4.1 to 10 range, and another 20% in the 10 to 20 PSA range.

As of the publication of the study, follow-up with the patient group showed 90.9% (209 of the 230 patients) with no evidence of disease. Of the 21 patients diagnosed with clinical recurrence of cancer, seven (3%) exhibited local failure and 14 had developed cancer elsewhere in their bodies.

Significantly, the cancer was biochemically controlled in 83.5 percent of patients tested nine years following Pd-103 treatment. Five years following treatment, 94% of patients with Gleason scores of less than 7 and PSAs of less than 10 were cancer free.

“Brachytherapy is an increasingly popular treatment option among both patients and physicians because of treatment convenience and the perception of minimal long-term morbidity, 1, 49, 50” the study concluded. “However, most published data have been of short follow-up and utilized the radioisotope I-125. The 9-year results using Pd-103 in this series add to the growing body of knowledge that brachytherapy can achieve a high rate of biochemical and clinical control for patients with clinically organ-confined disease.”

[1] Blasko JC, Ragde H, Luse RW, et al. Should Brachytherapy be Considered a Therapeutic Option in Localized Prostate Cancer? Urol Clin North Am 1996; 23:633-649.
[49] Arterbery VE, Frazier A, Dalmia P, et al. Quality of Life After Permanent Prostate Implant. Semin Surg Oncol 1997; 13:461-464.
[50] Blasko JC, Ragde H, Grimm PD. Transperineal Ultrasound-Guided Implantation of the Prostate: Morbidity and Complications. Scand J Urol Nephrol Suppl 1991; 137:113-118.

Principal Investigator: John C. Blasko, M.D., Seattle Prostate Institute, Seattle, Wash.