Brachytherapy a Good Option for Younger Prostate Cancer Patients

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Brachytherapy (BT) provides excellent long-term outcomes for relatively young men with clinically localized prostate cancer (PCa), researchers reported.

In a study of 236 men aged 60 years or younger with clinically localized PCa, BT alone or in combination with external beam radiation therapy (EBRT) was associated with eight-year PSA relapse-free survival (RFS), cancer-specific survival, and overall survival rates of 96%, 99%, and 96%, respectively, according to findings published in BJU International (2013;111:1231-1236). BT-based approaches also were associated with a low risk of long-term genitourinary  (GI) and gastrointestinal (GI) morbidities, with erectile function preserved in more than half of patients.

“Given these favorable outcomes,” the investigators concluded, “we strongly believe that young men should be offered BT as a treatment choice for clinically localized prostate cancer.”

The researchers, Marisa A. Kollmeier, MD, and colleagues at Memorial Sloan-Kettering Cancer Center in New York, noted that contemporary series examining radical prostatectomy, EBRT, and BT indicate excellent cancer-specific outcomes among younger patients, suggesting that PCa is not necessarily more aggressive in younger men. Despite evidence that radiation treatments are appropriate for young patients, clinicians still tend to favor radical surgery for this patient population, they observed.

A major advantage of BT-based treatment, Dr. Kollmeier's team wrote, is the ability to escalate intraprostatic doses above those of EBRT with minimal dose to normal surrounding tissue.

“Improved dose conformality will result in a reduction of normal tissue radiation exposure and holds the potential for reduced late toxicity and improved quality-of-life outcomes for patients,” they wrote. “Young men with longer life expectancies, therefore, are the population most likely to benefit from reduced normal tissue toxicity, particularly erectile preservation.”

Of the 236 men in the study, 178 had low-risk and 58 had high-risk disease. BT was given as monotherapy to 169 men or with EBRT to 67 patients. The median follow-up was 83 months. All patients had a minimum follow-up of three years.

For the low-risk and intermediate-risk patients, the eight-year PSA RFS rates were 97% and 94% respectively, a non-significant difference. The study revealed no difference in PSA RFS between BT alone and combined therapy. Late grade 2 or greater GU and GI toxicity rates were 14% and 3%, respectively.

In addition, of 150 men who were potent before treatment, 76 (51%) were potent at last follow-up, with 50 (66%) of these patients not using erectile dysfunction medication. Post-treatment potency rates were similar for the BT only and the combination treatment groups.

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