Brachytherapy for High-Risk Prostate Cancer Offers Favorable Outcomes

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Men who undergo brachytherapy for high-risk prostate cancer (PCa) are two times more likely to die from diseases of the heart than from the PCa, according to researchers.

The researchers, led by Gregory S. Merrick, MD, Director/Urologic Research Institute, Wheeling Jesuit University, Wheeling, W.Va., studied 284 PCa patients treated with brachytherapy for  high-risk disease, defined high-risk PCa as Gleason score of 8 or higher or PSA level greater than 20 ng/mL or clinical stage T2c or higher. Of the 284 patients, 257 received supplemental external beam radiation therapy and 179 received androgen deprivation therapy. All patients underwent brachytherapy—which was performed by Dr. Merrick—more than four years prior to analysis. Subjects had a mean follow-up period of 7.8 years.

The 12-year cancer-specific survival, biochemical progression-free survival, and overall survival rates were 94.2%, 89.0%, and 69.7%, respective, the investigators reported online in BJU International. In addition, 14% of patients died from diseases of the heart, whereas 6% died from PCa, 8% died from cancers other than PCa, and 8% died from other causes. Diseases of the heart accounted for 38.9% of all deaths, whereas PCa, non-PCa cancers, and other causes accounted for 16.7%, 22.2%, and 22.2%, respectively.

The 12-year overall survival was significantly greater among men with 0-3 comorbidities compared with those who had four or more comorbidities (71.9% vs. 52.7%).

Dr. Merrick's group concluded that high-quality prostate brachytherapy results in favorable biochemical control rates and cause-specific survival for men with high-risk PCa.

“In conjunction with results from other institutions, our results further substantiate the efficacy of high-quality brachytherapy in the management of high-risk prostate cancer patients,” the authors wrote.

In an accompanying editorial, Mark Roach, MD, observed that although “most of Dr. Merrick's patients were cured and they qualified as having high-risk disease by today's standards, in my view they were not truly ‘high-risk' for dying of prostate cancer. This criticism is not directed at Dr. Merrick's study but at our current standards for defining ‘high-risk' prostate cancer.”

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