A PSA level above 10 ng/mL and possibly age greater than 70 years are significantly associated with an increased risk for prostate cancer-specific mortality (PCSM) among men treated with brachytherapy (BT) for intermediate-risk prostate cancer, regardless of whether they also receive androgen deprivation therapy (ADT), according to a recent study.
David D. Yang, MD, of Dana-Farber Cancer Institute in Boston, Massachusetts and colleagues conducted a prospective cohort study of 1920 men with biopsy Gleason 3+4 prostate cancer who received BT. Of these, 1420 received BT alone and 500 received BT plus ADT for a median of 4 months. Over a median follow-up period of 7.8 years, 284 patients (14.8%) died. Of the 31 (10.9%) who died from prostate cancer, 18 (58%) were in the BT-only group and 13 (42%) were in the BT-ADT group.
In the patients in the BT-only group, each 1% increase in positive biopsies (PPB) was significantly associated with a 1.5% increased risk for PCSM after adjusting for multiple variables, Dr Yang’s team reported in Urologic Oncology. A PSA level of 10.1-20.0 ng/mL was significantly associated with a 5.6-fold increased risk for PCSM compared with a level of 4.0-10.0 ng/mL. Age older than 70 years was significantly associated with a 3.7-fold increased risk for PCSM compared with age 70 years or younger.
Among men who received BT plus ADT, increasing PPB and older age were not significantly associated with increased PCSM risk. A PSA level of 10.1-20.0 ng/mL was significantly associated with a 4.2-fold increased risk for PCSM compared with a level of 4.0-10.0 ng/mL.
Noting that PPB was no longer associated with a significant increase in PCSM when a median of 4 months of ADT was added to BT, the investigators stated: “It may be that as the volume of disease as assessed on biopsy increases, the cytoreductive effects of ADT allow for more effective delivery of BT.”
“Should these findings be validated in future studies, then advanced imaging and targeted biopsy of suspicious areas should be investigated in an effort to personalize treatment and minimize the risk of PCSM in these men,” the authors concluded.
Yang DD, Chen MH, Wu J, Braccioforte MH, Moran BJ, D’Amico AV. The risk of death from prostate cancer in men with Gleason score 3+4 prostate cancer treated using brachytherapy with or without a short course of androgen deprivation therapy. Urol Oncol. Published online July 24, 2021. doi:10.1016/j.urolonc.2021.07.002