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How long is long enough to secure disease control after low-dose-rate brachytherapy in combination with other modalities in intermediate-risk, localized prostate cancer?

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Abstract

Purpose

Previous studies have demonstrated excellent overall outcomes in patients who underwent low-dose-rate brachytherapy (LDR-BT) in intermediate-risk, localized prostate cancer (PCa). We thus investigated the appropriate length of time before completing prostate-specific antigen (PSA) monitoring after treatment.

Patients and Methods

Between 2003 and 2014, 710 localized, intermediate-risk PCa patients underwent LDR-BT with or without supplemental external beam radiotherapy (EBRT). Data from 567 of those patients was analyzed in this study. Neoadjuvant hormonal therapy (NHT) was administered to 315 patients (55.6 %) and NHT with adjuvant hormonal therapy (AHT) to 59 patients (10.4 %), as per the protocol of a prospective randomized controlled trial (SHIP0804). We stratified patients by posttreatment PSA levels at specific times and assessed the factors for association with biochemical recurrence (BCR) and for clinical progression (CP).

Results

The median follow-up was 109 months (range, 60-205 months). Of 529 patients who were BCR-free at 3 years after treatment, 56 subsequently developed BCR, and 47 developed CP. PSA at 3 and 5 years after treatment were significantly correlated with long-term oncological outcomes. No patients with 5-year PSA levels ≤0.1 ng/mL subsequently developed BCR or CP.

Conclusion

Discontinuation of PSA monitoring could be discussed with patients with intermediate-risk PCa as a reasonable option if PSA levels remain ≤0.1 ng/mL at 5 years after LDR-BT, either alone or with other combined modalities, as subsequent recurrences are quite rare.

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Acknowledgements

This study was supported in part by a grant of SHIP0804 (NCT00664456). English-language editorial support was provided by Seaman Medical, Inc., Bellingham WA, USA.

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Authors and Affiliations

  1. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Fumihiko Urabe, Takahiro Kimura, Hiroshi Sasaki, Kojiro Tashiro, Kosuke Iwatani, Keiji Yasue, Kenta Miki & Shin Egawa

  2. Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan

    Manabu Aoki

  3. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan

    Shun Sato & Hiroyuki Takahashi

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  1. Fumihiko Urabe
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Correspondence to Fumihiko Urabe.

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Urabe, F., Kimura, T., Sasaki, H. et al. How long is long enough to secure disease control after low-dose-rate brachytherapy in combination with other modalities in intermediate-risk, localized prostate cancer?. Int J Clin Oncol 27, 184–193 (2022). https://doi.org/10.1007/s10147-021-02040-5

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