Long-term outcomes in patients younger than 60 years of age treated with brachytherapy for prostate cancer

Langzeitergebnisse einer Brachytherapie des Prostatakarzinoms bei Patienten unter 60 Jahren

Abstract

Purpose

The purpose of the study was to report the outcomes and late toxicities in patients younger than 60 years of age with long-term follow-up treated with low dose rate (LDR) brachytherapy for localized prostate cancer.

Methods

Between January 2000 and December 2009, 270 consecutive patients were treated with favourable localized prostate cancer; the median follow-up was 111 months (range 21–206). All patients received one implant of LDR brachytherapy. Toxicity was reported according to the Common Toxicity Criteria for Adverse Events, Version 4.0 (CTAE v4.02) by the National Cancer Institute.

Results

The overall survival according to Kaplan–Meier estimates was 99 (±1%) at 17 years. The 17-year rate for failure in tumour-free survival (TFS) was 97% (±1%), whereas for biochemical control it was 95% (±1%) at 17 years, 97% (±1%) of patients being free of local recurrence. No intraoperative or perioperative complications occurred. Acute genitourinary (GU) grade II toxicity was 4% at 12 months. No other chronic toxicity was observed after treatment. At 6 months, 94% of patients reported no change in bowel function.

Conclusions

LDR brachytherapy provides patients younger than 60 years of age with low and intermediate-risk prostate cancer excellent outcomes and has a low risk of significant long-term GU or gastrointestinal morbidity.

Zusammenfassung

Zielsetzung

Ziel der Studie war es, im Langzeit-Follow-up die Behandlungsergebnisse und die Spättoxizität bei Patienten unter 60 Jahren, die eine niedrig dosierte Brachytherapie („low dose rate“ [LDR]) bei lokal begrenztem Prostatakarzinom erhielten, zu erfassen.

Methoden

Von Januar 2000 bis Dezember 2009 wurden 270 konsekutive Patienten mit günstig lokalisiertem Prostatakarzinom behandelt; die Follow-up-Dauer betrug im Median 111 Monate (Spanne 21–206 Monate). Jeder Patient erhielt ein Implantat für die LDR-Brachytherapie. Die Toxizität wurde gemäß den Common Toxicity Criteria for Adverse Events, Version 4.0 (CTCAE v4.02), des National Cancer Institute erfasst.

Ergebnisse

Das Gesamtüberleben nach einer Kaplan-Meier-Schätzung betrug 99 % (±1 %) nach 17 Jahren. Die 17-Jahres-Rate für das Versagen im tumorfreien Überleben lag bei 97 % (±1 %), die für die biochemische Kontrolle bei 95 % (±1 %) nach 17 Jahren, 97 % (±1 %) der Patienten hatten kein lokales Rezidiv. Intraoperative oder perioperative Komplikationen ereigneten sich nicht. Die urogenitale Grad-II-Toxizität betrug nach 12 Monaten 4 %. Eine anderweitige chronische Toxizität wurde nach der Behandlung nicht beobachtet. Nach 6 Monaten gaben 94% der Patienten keine Veränderungen in der Darmfunktion an.

Schlussfolgerungen

Mit der LDR-Brachytherapie werden bei Patienten unter 60 Jahren mit Low-risk- oder Intermediate-risk-Prostatakarzinom hervorragende Ergebnisse erzielt. Das Risiko einer signifikanten langfristigen Morbidität im urogenitalen oder gastrointestinalen Bereich ist gering.

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Abbreviations

AJCC:

American Joint Committee on Cancer

BT:

Brachytherapy

EBRT:

External beam radiotherapy

CTAE v4.02:

Common Toxicity Criteria for Adverse Event, version 4.02

D90:

The dose that covers 90% volume of CTV

GI:

Gastrointestinal

GU:

Genitourinary

LDR:

Low dose rate

PSA:

Serum prostate-specific antigen

SPSS:

Statistical analysis SPSS

SD:

Standard deviations

TFS:

Tumor-free survival

TG-43:

Task group 43 (American Association of Physicist in Medicine)

TRUS:

Transrectal ultrasound

References

  1. 1.

    Jang TL, Yossepowitch O, Bianco FJ Jr, Scardino PT (2007) Low risk prostate cancer in men under age 65:the case for definitive treatment. Urol Oncol 25(3):510–514

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Merrick GS, Wallner KE, Butler WM et al (2006) Brachytherapy in men aged〈 or = 54 years with clinically localized prostate cancer. BJU Int 98(8):324

    Article  PubMed  Google Scholar 

  3. 3.

    Burri RJ, Ho AY, Forsythe K, Cesaretti JA, Stone NN, Stock RG (2010) Young men have equivalent biochemical outcomes compared with older men after treatment with brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys 77:1315–1321

    Article  PubMed  Google Scholar 

  4. 4.

    Khan MA, Han M, Partin AW, Epstein JI, Walsh PC (2003) Long-term cancer control of radical prostatectomy in men younger than 50 years of age: update 2003. Urology 62:86–89

    Article  PubMed  Google Scholar 

  5. 5.

    Zelefsky MJ, Marion C, Fuks Z, Improved LSA (2003) Improved biochemical disease-free survival of men younger than 60 years with prostate cancer treated with high dose conformal external beam radiotherapy. J Urol 170:1828–1832

    Article  PubMed  Google Scholar 

  6. 6.

    Yamada Y, Bhatia S, Zaider M et al (2006) Favorable clinical outcomes of three-dimensional computer-optimized high-dose-rate prostate brachytherapy in the management of localized prostate cancer. Brachytherapy 5:157–164

    Article  PubMed  Google Scholar 

  7. 7.

    Fleming I, Cooper JS, Henson DE et al (1997) AJCC cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia

    Google Scholar 

  8. 8.

    Zelefsky MJ, Leibel SA, Gaudin PB et al (1998) Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 41:491–500

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Bice WS Jr., Prestidge BR, Prete JJ et al (1998) Clinical impact of implementing the recommendations of AAPM Task Group 43 on permanent prostate bachytherapy using 125I. American Association of Physicists in Medicine. Int J Radiat Oncol Biol Phys 40:1237–1241

    Article  PubMed  Google Scholar 

  10. 10.

    Prada PJ, Juan G, Fernandez J et al (2006) Conformal prostate brachytherapy guided by real-time dynamic dose calculation in permanent I‑125 implants: technical description and preliminary experience. Arch Esp Urol 59(9):933–940

    Article  PubMed  Google Scholar 

  11. 11.

    Subir N, Ciezki Cormack LPR et al (2001) Intraoperative planning and evaluation of permanente prostate brachytherapy: report of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys 51:1422–1430

    Article  Google Scholar 

  12. 12.

    Prada PJ, Fernandez J, Martinez A et al (2007) Transperineal injection of hyaluronic acid in the anterior peri-rectal fat to decease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Biol Phys 69(1):95–102

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Prada PJ, Herminio Gonzalez, Menendez C et al (2009) Transperineal injection of hyaluronic acid in the anterior peri-rectal fat to decrease rectal toxicity from radiation delivered with low dose rate brachytherapy for prostate cancer patients. Brachytherapy 8(2):210–217

    Article  PubMed  Google Scholar 

  14. 14.

    Roach M, Hanks G, Thames H, Schellhammer P, Shipley WU, Sokol GH, Sandler H (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974

    Article  PubMed  Google Scholar 

  15. 15.

    Rosser CJ, Kamat AM, Wang X et al (2006) Biochemical disease-free survival in men younger than 60 years with prostate cancer treated with radical prostatectomy. Urology 67:769–773

    Article  PubMed  Google Scholar 

  16. 16.

    Merrick GS, Butler WM, Wallner KE, Galbreath RW, Adamovich E (2004) Permanent interstitial brachytherapy in younger patients with clinically organ-confined prostate cancer. Urology 64:754–759

    Article  PubMed  Google Scholar 

  17. 17.

    Pina AG, Crook JM, Kwan P, Borg J, Ma C (2010) The impact of perineural invasion on iochemical outcome after permanent prostate iodine-125 brachytherapy. Brachytherapy 9:213–218

    Article  PubMed  Google Scholar 

  18. 18.

    Shapiro EY, Rais-Bahrami S, Morgenstern C, Napolitano B, Richstone L, Potters L (2009) Long-term outcomes in younger men following permanent prostate brachytherapy. J Urol 181:1665–1671

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Kollmeier MA, Fidaleo A, Pei X et al (2013) Favourable long-term outcomes with brachytherapy-based regimens in men ≤60 years with clinically localized prostate cancer. BJU Int 111:1231–1236

    Article  PubMed  Google Scholar 

  20. 20.

    Buckstein M, Carpenter TJ, Stone NN, Stock RG (2013) Long-term outcomes and toxicity in patients treated with brachytherapy for prostate adenocarcinoma younger than 60 years of age at treatment with minimum 10 years of follow-up. Urology 81:364–369

    Article  PubMed  Google Scholar 

  21. 21.

    Joseph L, Al-Qaisieh B, Ash D et al (2004) Prostate-specific antigen relapse-free survival in patients with localized prostate cancer treated by brachytherapy. BJU Int 94:1235–1238

    Article  PubMed  Google Scholar 

  22. 22.

    Zelefsky MJ, Hollister T, Raben A et al (2000) Five year biochemical outcome and toxicity with transperineal CT planned permanent iodine 125 prostate implantation for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 47:1261–1266

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Stone NS, Stock RG (2003) 10-Year biochemical and local control following real-time I‑125 prostate brachytherapy. J Urol 169(4 suppl):459

    Google Scholar 

  24. 24.

    Bottomley D, Ash D, Al-Qaisieh B et al (2007) Side effects of permanent I‑125 prostate implants in 667 patients treated in Leeds. Radiother Oncol 82:46–49

    Article  PubMed  Google Scholar 

  25. 25.

    Gutman S, Merrick GS, Butler W et al (2006) Severity categories of the international prostate symptom score before, and urinary morbidity after, permanent brachytherapy. BJU Int 97:62–68

    Article  PubMed  Google Scholar 

  26. 26.

    Henderson AS, Ismael AK, Cunnigham M et al (2004) Toxicity and early biochemical outcomes from iodine 125 prostate brachytherapy in the UK. A prospective study. Clin Oncol 16:95–104

    CAS  Article  Google Scholar 

  27. 27.

    Merrick GS, Butler WM, Galbreath RW et al (2002) Erectil function after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 52:893–902

    Article  PubMed  Google Scholar 

  28. 28.

    Ohashi T, Yorozu A, Toya K et al (2006) Serial changes of international prostate symptom score following I‑125 prostate brachytherapy. Int J Clin Oncol 11:320–325

    Article  PubMed  Google Scholar 

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Correspondence to Pedro J. Prada M.D., Ph.D..

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Conflict of interest

P.J. Prada, J. Cardenal, A. García Blanco, J. Anchuelo, M. Ferri, I. Diaz de Cerio, A. Vázquez, M. Pacheco and S. Ruiz Arrebola declare that they have no competing interests.

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Prada, P.J., Cardenal, J., García Blanco, A. et al. Long-term outcomes in patients younger than 60 years of age treated with brachytherapy for prostate cancer. Strahlenther Onkol 194, 311–317 (2018). https://doi.org/10.1007/s00066-017-1238-2

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Keywords

  • Brachytherapy
  • Prostate cancer
  • Younger patients
  • Outcome
  • Morbidity

Schlüsselwörter

  • Brachytherapie
  • Prostatakrebs
  • Jüngere Patienten
  • Behandlungsergebnis
  • Morbidität