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Clinical and Translational Oncology

, Volume 14, Issue 5, pp 369–375 | Cite as

Biochemical control of prostate cancer with iodine-125 brachytherapy alone: experience from a single institution

  • Larissa Pereira da Ponte Amadei
  • João Luis Fernandes Silva
  • Samir Abdallah Hanna
  • Cecília Maria Kalil Haddad
  • Adriano João Nesrallah
  • Heloisa Andrade CarvalhoEmail author
Research Articles

Abstract

Aim

Brachytherapy is an adequate option as monotherapy for localised prostate cancer. The objective of this study was to evaluate and compare biochemical failure free survival (BFFS) after low-dose-rate brachytherapy (LDRB) alone for patients with prostate cancer using ASTRO and Phoenix criteria, and detect prognostic factors.

Methods

Data on 220 patients treated between 1998 and 2002 with LDRB were retrospectively analysed. Neoadjuvant hormone therapy was used in 74 (33.6%) patients.

Results

Median follow-up was 53.5 months (24–116). Five year BFFS was 83.0% and 83.7% using, respectively, the ASTRO and Phoenix criteria. Low -and intermediate-risk patients presented, respectively, 86.7% and 77.8% 5-year BFFS using the ASTRO definition (p=0.069), and 88.5% and 78.6% considering the Phoenix criteria (p=0.016). Bounce was observed in 66 (30%) patients. Multivariate analysis detected PSA at diagnosis <10 ng/ml and less than 50% positive biopsy fragments as favourable prognostic factors, regarding BF using both criteria. For the Phoenix criteria, also Gleason score <7 and low-risk group were identified as independent favourable prognostic factors.

Conclusions

LDRB alone should be considered mostly for low-risk patients. PSA level was a strong independent prognostic factor. We support the use of the Phoenix criteria for detection of BF in patients submitted to LDRB alone.

Keywords

Prostate neoplasm Biochemical failure Low dose-rate brachytherapy Radiotherapy Monotherapy 

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References

  1. 1.
    Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96PubMedCrossRefGoogle Scholar
  2. 2.
    Brasil. Ministério da Saúde. Estimativa 2010. Incidência de Câncer no Brasil. Available at www.inca.gov.br
  3. 3.
    Holm HH, Juul N, Pedersen JF et al (1983) Transperineal 125-Iodine seed implantation in prostatic cancer guided by transrectal ultrasonography. J Urol 130:283–286PubMedGoogle Scholar
  4. 4.
    Radge H, Korb LJ, Elgamal AA et al (2000) Modern prostate brachytherapy. Prostate specific antigen results in 219 patients with up to 12 years of observed follow-up. Cancer 89:135–141CrossRefGoogle Scholar
  5. 5.
    American Society for Therapeutic Radiation Oncology Consensus Panel (1997) Consensus statement: guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 37:1035–1041Google Scholar
  6. 6.
    Roach M III, Hanks G, Thames H Jr et al (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 65:965–974PubMedCrossRefGoogle Scholar
  7. 7.
    (2011) NCCN guidelines Version 1. Prostate Cancer. Available at www.nccn.org
  8. 8.
    Cavanagh W, Blasko JC, Grimm PD et al (2000) Transient elevation of serum prostate-specific antigen following 125I/103Pd brachytherapy for localized prostate cancer. Semin Urol Oncol 18: 160–165PubMedGoogle Scholar
  9. 9.
    Crook JM, Choan E, Perry GA et al (1998) Serum prostate-specific antigen profile following radiotherapy for prostate cancer: implications for patterns of failure and definition of cure. Urology 51:566–572PubMedCrossRefGoogle Scholar
  10. 10.
    Stock RG, Stone NN, Cesaretti JA (2003) Prostate-specific antigen bounce after prostate seed implantation for localized prostate cancer: descriptions and implications. Int J Radiat Oncol Biol Phys 56:448–453PubMedCrossRefGoogle Scholar
  11. 11.
    Ciezk JP, Reddy CA, Garcia J et al (2006) PSA kinetics after prostate brachytherapy: PSA bounce phenomenon and its implications for PSA doubling time. Int J Radiat Oncol Biol Phys 64:512–517CrossRefGoogle Scholar
  12. 12.
    Pickles T (2006) Prostate-specific antigen (PSA) bounce and other fluctuations: which biochemical relapse definition is least prone to PSA false calls? An analysis of 2030 men treated for prostate cancer with external beam or brachytherapy with or without adjuvant androgen deprivation therapy. Int J Radiat Oncol Biol Phys 64:1355–1359PubMedCrossRefGoogle Scholar
  13. 13.
    Critz FA, Levinson AK, Williams WH et al (1997) The PSA nadir that indicates potential cure after radiotherapy for prostate cancer. Urology 49:322–326PubMedCrossRefGoogle Scholar
  14. 14.
    Perez CA, Michalsky JM, Lockett MA (2001) Chemical disease free survival in localized carcinoma of prostate treated with external beam irradiation: comparison of American Society of Therapeutic Radiology and Oncology Consensus or 1ng/mL as end point. Int J Radiat Oncol Biol Phys 49:1287–1296PubMedCrossRefGoogle Scholar
  15. 15.
    Ray ME, Thames HD, Levy LB et al (2006) PSA nadir predicts biochemical and distant failure after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys 64:1140–1150PubMedCrossRefGoogle Scholar
  16. 16.
    Pickles T, Kim-Sing C, Morris WJ et al (2003) Evaluation of the Houston biochemical relapse definition in men treated with prolonged neoadjuvant adjuvant androgen ablation and assessment of follow-up lead-time bias. Int J Radiat Oncol Biol Phys 57:11–18PubMedCrossRefGoogle Scholar
  17. 17.
    Horwitz EM, Thames HD, Kuban DA et al (2005) Definitions of biochemical failure that best predict clinical failure in patients with prostate cancer treated with external beam radiation alone: a multi-institutional pooled analysis. J Urol 173:797–802PubMedCrossRefGoogle Scholar
  18. 18.
    Fitch DL, McGrath S, Martinez AA et al (2006) Unification of a common biochemical failure definition for prostate cancer treated with brachytherapy or external beam radiotherapy with or without androgen deprivation Int J Radiat Oncol Biol Phys 66:1430–1439PubMedCrossRefGoogle Scholar
  19. 19.
    Guedea F, Ramos A, Herruzo I et al (2010) Treatment of localised prostate cancer with radiation therapy: evidence versus opinion. Clin Transl Oncol 12:315–317PubMedCrossRefGoogle Scholar
  20. 20.
    Grimm PD, Blasko JC, Sylvester JE et al (2001) 10-year biochemical (prostate specific antigen) control of prostate cancer with 125I brachytherapy. Int J Radiat Oncol Biol Phys 51:31–40PubMedCrossRefGoogle Scholar
  21. 21.
    Crook J, Borg J, Evans A et al (2011) 10-Year experience with I-125 prostate brachytherapy at the Princess Margaret Hospital: results for 1,100 patients. Int J Radiat Oncol Biol Phys 80:1323–1329PubMedCrossRefGoogle Scholar
  22. 22.
    Franca CAS, Vieira SL, Bernabe AJS, Penna ABR (2001) The seven-year preliminary results of brachytherapy with iodine-125 seeds for localized prostate cancer treated at a Brazilian single-center. Int Braz J Urol 33:752–763Google Scholar
  23. 23.
    Guedea F, Aguilo F, Polo A et al (2006) Early biochemical outcomes following permanent interstitial brachytherapy as monotherapy in 1050 patients with clinical T1-T2 prostate cancer. Radiother Oncol 80:57–61PubMedCrossRefGoogle Scholar
  24. 24.
    Kwok Y, DiBiase SJ, Amin PP et al (2002) Risk group stratification in patients undergoing permanent (125)I prostate brachytherapy as monotherapy. Int J Radiat Oncol Biol Phys 53:588–594PubMedCrossRefGoogle Scholar
  25. 25.
    Stamey TA, Sozen TS, Yemoto CM, McNeal JE (1998) Classification of localized untreated prostate cancer based on 791 men treated only with radical prostatectomy: common ground for therapeutic trials and TNM subgroups. J Urol 159:2009–2012PubMedCrossRefGoogle Scholar
  26. 26.
    Stock RG, Stone NN, Tabert A et al (1998) A dose-response study for I-125 prostate implants. Int J Radiat Oncol Biol Phys 41:101–108PubMedCrossRefGoogle Scholar
  27. 27.
    Zelefsky MJ, Wallner KE, Ling C et al (1999) Comparison of the 5-year outcome and morbidity of the three-dimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early-stage prostatic carcinoma. J Clin Oncol 17:517–522PubMedGoogle Scholar
  28. 28.
    Stock RG, Stone NN, Kao J (2000) The effect of disease and treatment-related factors on biopsy results after prostate brachytherapy: implications for treatment optimization. Cancer 89:1829–1834PubMedCrossRefGoogle Scholar
  29. 29.
    Partin AW, Epstein JI, Cho KR et al (1989) Morphometric measurement of tumor volume and per cent of gland involvement as predictors of pathological stage in clinical stage B prostate cancer. J Urol 141:341–345PubMedGoogle Scholar
  30. 30.
    Kato RB, Srougi V, Salvadori FA et al (2008) Pretreatment tumor volume estimation based on total serum PSA in patients with localized prostate cancer. Clinics 63:759–762PubMedCrossRefGoogle Scholar
  31. 31.
    D’Amico AV, Whitting R, Malkowicz SB et al (2000) Clinical utility of percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer. J Clin Oncol 18: 1164–1172PubMedGoogle Scholar
  32. 32.
    Guedea F, Ventura M, Londres B et al (2011) Over view of brachytherapy resources in Latin America: a patterns-of-care survey. Brachytherapy 10:363–368PubMedCrossRefGoogle Scholar

Copyright information

© Feseo 2012

Authors and Affiliations

  • Larissa Pereira da Ponte Amadei
    • 1
    • 2
    • 3
  • João Luis Fernandes Silva
    • 4
  • Samir Abdallah Hanna
    • 4
  • Cecília Maria Kalil Haddad
    • 4
  • Adriano João Nesrallah
    • 5
    • 6
  • Heloisa Andrade Carvalho
    • 7
    • 6
    Email author
  1. 1.Departmento de Radiologia/RadioterapiaFaculdade de Medicina da Universidade de São Paulo and Sociedade Beneficente de SenhorasSão Paulo, SPBrazil
  2. 2.Hospital Sírio-Libanês SãoPaulo, SPBrazil
  3. 3.Santa Casa de SobralFaculdade de Medicina da Universidade Federal do CearáSobral, CEBrazil
  4. 4.Department of Radiotherapy, Sociedade Beneficente de SenhorasHospital Sírio-LibanêsSão Paulo, SPBrazil
  5. 5.Department of UrologyHospital das Clínicas da FMUSP/ICESPSão Paulo, SPBrazil
  6. 6.Sociedade Beneficente de SenhorasHospital Sírio-LibanêsSão Paulo, SPBrazil
  7. 7.Departmento de Radiologia/Radioterapia Hospital Das ClínicasUniversity of São PauloSão Paulo, SPBrazil

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