Brachytherapy For Prostate Cancer Sufficient Without Adjuvant Treatment

NEW YORK OCT 05, 2005 (Reuters Health) - Twelve-year outcomes following permanent prostate brachytherapy suggest that neither adjuvant hormone therapy nor external beam radiation is required for effective treatment of mild or intermediate, clinically localized prostate cancer.

These findings were reported this week at the annual meeting of the American Society for Therapeutic Radiology and Oncology in Atlanta.

"When dosimetry is done well, what we see on multivariate analysis is the lack of influence of adjuvant therapy, such as hormone therapy or the addition of external beam radiation," lead investigator Dr. Louis Potters of the New York Prostate Institute in Oceanside, New York, told Reuters Health.

Dr. Potters" group followed 1504 patients treated with brachytherapy using Iodine-125 or palladium-103 between 1992 and 2000.  Adjuvant or neoadjuvant hormones were used in 408 (27%) of patients, while 305 (20%) were also treated with external radiation.

Disease-specific survival at 12 years was 84%, with an overall survival of 93%, they report.

Pretreatment prostate specific antigen (PSA), Gleason score and dosimetry were significantly associated with outcome.  In contrast, biochemical failure was not significantly associated with clinical stage, the addition of hormones or external radiation, or isotope selection.

Disease-specific survival was 65% when PSA doubling time was less than 12 months, versus 92% when PSA doubling time was longer.  More aggressive salvage treatment may be needed for patients with shorter PSA doubling times, the investigators suggest.

"Clearly, in low-risk or intermediate-risk patients, brachytherapy as monotherapy seems to be as good as combination therapy," Dr. Potters said.

"Urologists are constantly talking about surgery being the gold standard and that we have no long-term data with seed implants," he added.  "This is a very large study of brachytherapy that shows at 12 years, it"s as good as surgery in terms of biochemical failure rate."

There is a low rate of impotence and there are almost no episodes of incontinence, he continued.  Patients do not have to wear a catheter for an extended period of time, and they can usually return to work within 2 days of undergoing brachytherapy.

Therefore, offering the procedure to patients with clinically localized prostate cancer "is almost a no-brainer," he concluded.


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