In a nutshell
This study assessed the effectiveness of a brachytherapy algorithm as administered to patients with localized prostate cancer.
Some background
Patients with localized prostate cancer (cancer that has not spread) may be treated using a high-energy radiation that kills cancer cells (radiotherapy). Brachytherapy is a form of radiotherapy which involves inserting radioactive implants into the prostate gland. Brachytherapy may be administered in combination with androgen deprivation therapy (treatment to reduce male hormones that stimulate prostate cancer cells to grow) or external beam radiation therapy where an external source of radiation is pointed towards the prostate gland. Decisions to use brachytherapy alone or in conjunction with another therapy can be based on an algorithm (a process to be followed in problem-solving)of treatments, taking into account treatment cure rates, toxicity and post-treatment quality of life.
The following study assessed the use of a brachytherapy algorithm in localized prostate cancer.
Methods & findings
The study involved 2,495 patients treated for localized prostate cancer. 44% of patients were low-risk (Gleason score less than 6; cancer has low of spreading), 39% were intermediate-risk (Gleason score of 7; there is a chance of cancer spreading, though not high), and 17% high-risk (Gleason score greater than 8; cancer has a very high chance of spreading).
The treatment algorithm was as follows; the low risk patients were treated with brachytherapy alone. The intermediate patients were treated with androgen deprivation therapy and brachytherapy followed by external beam radiation therapy.The high risk patients were treated with a combination of androgen dreprivation therapy, brachytherapy and external beam radiation therapy concurrently.
The main parameters of analysis were freedom from biochemical failure (no recurrence as identified by a rise in PSA level), freedom from distant metastases (no spread of the cancer to organs that are far from the prostate gland), prostate cancer specific survival (taking into account mortality directly as a result of prostate cancer) and overall survival (number of patients who are still alive after they started treatment for a cancer).
After 12 yearsof follow-up, 83% of all patients were free from biochemical failure. Freedom from biochemical failure was 90% in the low-risk group, 84% in the intermediate-risk group and 64% in the high-risk group. The rate of biochemical failure was increased associated with increasing risk group and decreased associated with the use of androgen deprivation therapy.
95% of all patients were free from distant metastasis. 98% of the low-risk group, 95% of the intermediate-risk group and 85% of the low-risk group were free from distant metastasis.
Prostate cancer specific survival was 95% for all patients. Prostate cancer specific survival was 97% for the low-risk group, 98% for the intermediate-risk group and 84% for the high-risk group.
Overall survival was 70% for all patients. Overall survival for the low-risk group was 77%, 70% for the intermediate-risk group and 57% for the high-risk group.
The bottom line
In summary, this study supports previous data on brachytherapy as a primary treatment for prostate cancer with excellent results in effectiveness, survival and morbidity outcomes.
The fine print
The algorithm was developed by Mount Sinai Medical Center, who also sponsored the study.
Published By :
Urologic oncology
Date :
Jan 01, 2014
