LDR Brachytherapy for Prostate Cancer Offers Excellent Survival

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Brachytherapy for localized prostate cancer is associated with high 17-year rates of cancer-specific and distant metastases-free survival rates.
Brachytherapy for localized prostate cancer is associated with high 17-year rates of cancer-specific and distant metastases-free survival rates.

Low-dose-rate brachytherapy (LDR-BT) for localized prostate cancer is associated with excellent disease-specific survival rates and appears to be an effective alternative to radical prostatectomy (RP), researchers concluded.

In a study that included 757 men with localized PCa who underwent definitive LDR-BT from 1990 to 2006 and followed up for more than 10 years (median 12.5 years), Stanislav Lazarev, MD, and colleagues at the Icahn School of Medicine at Mount Sinai in New York found that 88.6% of patients were alive at the time of their analysis, 1.5% died from PCa, and 13.9% experienced biochemical failure, according to study findings published online ahead of print in BJU International. Distant metastases developed in 2.3% of patients.

The overall 17-year rates for biochemical failure-free survival (BFFS), distant metastases-free survival, prostate cancer-specific survival, and overall survival were 79%, 97%, 97%, and 72%, respectively, Dr. Lazarev and his colleagues reported.

Among the patients who experienced biochemical failure, 18% did so more than 10 years after brachytherapy, “which justifies their continued follow-up,” the researchers stated.

On multivariate analysis, stage T3a–T3b disease, PSA levels above 20 ng/mL, and intermediate- and high-risk disease predicted worse BFFS. Age older than 70 years at diagnosis and stage T3a–T3b disease predicted worse overall survival.

When compared with available data on long-term PCa-specific survival after radical prostatectomy (RP), LDR-BT appears to be an effective alternative, according to the investigators. They noted, for example, that a study of 2404 men who underwent RP for localized PCa at Johns Hopkins University in Baltimore found an actuarial 15-year PCa-specific rate of 90% at a mean follow-up of 6.3 years.

Reference

Lazarev S, Thompson MR, Stone NN, and Stock RG. Low-dose-rate brachytherapy for prostate cancer: outcomes at >10 years of follow-up. BJU Int. 2018 Jan 30.  doi: 10.111/bju.14122

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