Bicalutamide alone prior to brachytherapy achieves cytoreduction that is similar to luteinizing hormone-releasing hormone analogues with less patient-reported morbidity

Petit, Joshua H.; Gluck, Clifford; Kiger, W.S.; Henry, D. Laury; Karasiewicz, Carol; Talcott, James; Berg, Solomon; Holupka, Edward; Kaplan, Irving

doi:10.1016/j.urolonc.2007.05.014

« Previous Next »Urologic Oncology: Seminars and Original Investigations
Volume 26, Issue 4 , Pages 372-377, July 2008

Bicalutamide alone prior to brachytherapy achieves cytoreduction that is similar to luteinizing hormone-releasing hormone analogues with less patient-reported morbidity

Joshua H. Petit, M.D.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Corresponding author. Tel.: +1-617-667-2345; fax: +1-617-667-4990.
Clifford Gluck, M.D.
- Department of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
W.S. Kiger III, Ph.D.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
D. Laury Henry, B.S.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
Carol Karasiewicz, B.S.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
James Talcott, M.D.
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02214, USA
Solomon Berg, M.D.
- Department of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
Edward Holupka, Ph.D.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
Irving Kaplan, M.D.
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA

Received 3 April 2007; received in revised form 28 April 2007; accepted 8 May 2007. published online 10 January 2008.

Abstract

Objectives

To compare the impact of bicalutamide (B) vs. luteinizing hormone-releasing hormone analogues (LHRHa) on prostate volume, patient-reported side effects, and postimplant urinary toxicity in the setting of interstitial brachytherapy for early-stage prostate cancer.

Methods

Between May 1998 and January 2004, 81 patients received androgen-deprivation therapy (ADT) for cytoreduction prior to interstitial brachytherapy alone. Fifty-six patients received LHRHa and 25 patients received B. Prostate volumes were measured prospectively prior to initiating therapy, and then intraoperatively at the time of implant by a single, blinded ultrasonographer. Patient-reported quality of life data were obtained prospectively, and postimplant urinary toxicity (catheter dependency and need for surgical intervention) was recorded during follow-up. Median follow-up was 53 (range 23–78) months.

Results

The median percentage prostate volume reductions of 26% for B and 32% for LHRHa were not statistically different (P = 0.61). Decrements in libido (92% vs. 44%, P < 0.001) and erectile function (79% vs. 20%) were reported in more respondents treated with LHRHa than B. The incidence of recatheterization (28% vs. 24%, P = 0.34), and the need for subsequent surgical intervention (11% vs. 4%, P = 0.16) were similar for patients treated with LHRHa and B.

Conclusions

The degree of prostate downsizing with B is similar to that achieved with LHRHa. B was associated with fewer patient-reported sexual side effects and similar urinary morbidity. A randomized trial is needed to establish whether LHRHa or B should be the standard of care for prostate downsizing before interstitial brachytherapy.

Keywords: Bicalutamide, Brachytherapy, Prostate cancer, Volume reduction