Treatment of intermediate-risk prostate cancer with brachytherapy without supplemental pelvic radiotherapy: A review of the H. Lee Moffitt Cancer Center experience

Torres-Roca, Javier F.; Cantor, Alan B.; Shukla, Sonia; Montejo, Michael E.; Friedland, Jay; Seigne, John D.; Heysek, Randy; Pow-Sang, Julio

doi:10.1016/j.urolonc.2005.12.003

« Previous Next »Urologic Oncology: Seminars and Original Investigations
Volume 24, Issue 5 , Pages 384-390, September 2006

Treatment of intermediate-risk prostate cancer with brachytherapy without supplemental pelvic radiotherapy: A review of the H. Lee Moffitt Cancer Center experience☆

Presented at the 46th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Atlanta, GA, October 3–7, 2004.

Javier F. Torres-Roca, M.D.
- Department of Interdisciplinary Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Corresponding author. Tel.: +1-813-972-8424; fax: +1-813-979-7231.
Alan B. Cantor, Ph.D.
- Department of Interdisciplinary Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
Sonia Shukla
- Department of Interdisciplinary Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
Michael E. Montejo, B.S.
- Department of Interdisciplinary Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
Jay Friedland, M.D.
- Department of Interdisciplinary Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
John D. Seigne, M.B.
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
Randy Heysek, M.D.
- Department of Interdisciplinary Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
Julio Pow-Sang, M.D.
- Department of Interdisciplinary Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA

Received 27 June 2005; received in revised form 16 December 2005; accepted 22 December 2005.

Abstract

Purpose

To determine the biochemical outcomes of patients with intermediate-risk prostate cancer treated at the H. Lee Moffitt Cancer Center with an I-125 permanent seed implant without supplemental pelvic radiotherapy.

Methods and Materials

Under an institutional review board approved protocol, the charts of 88 patients with intermediate-risk prostate cancer and a minimum follow-up of 36 months treated with brachytherapy without supplemental pelvic radiotherapy were reviewed. Median follow-up for the whole cohort was 57 months (range 37–121). Biochemical failure was defined using the American Society for Therapeutic Radiology and Oncology definition.

Results

The 5-year biochemical failure-free survival for the cohort was 83%. Patients with perineural invasion had a worse biochemical outcome, which was statistically significant (perineural invasion vs. no perineural invasion, 5-year biochemical failure-free survival 64% vs. 89%, P = 0.004). None of the following factors were found significant in this subset of patients: Gleason scores 6 versus 7, primary Gleason grades 3 versus 4, percentage of core positive <20% versus >20%, number of cores positive <2 versus 2 versus >2, hormonal therapy versus no hormonal therapy, T1 versus T2, prostate-specific antigen <10 versus >10, or ≥2 intermediate risk factors versus 1 intermediate risk factor.

Conclusions

Our data suggest that patients with intermediate-risk prostate cancer may be treated effectively with brachytherapy without supplemental pelvic radiotherapy. However, because of the limited nature of our study, we cannot exclude that patients with intermediate-risk prostate cancer may benefit from supplemental external beam radiotherapy.

Keywords: Prostate cancer , Brachytherapy monotherapy , Perineural invasion