Progression of Prostate Cancer after Brachytherapy, Categorized by Risk groups
Keywords:
Progression, Prostate Cancer, Brachytherapy, Categorized, Risk groupsAbstract
Objective: To study the progression of prostate cancer after Brachytherapy in Phramongkutklao Hospital by using PSA as a surrogate of outcome. Using PSA to calculate for BRFS (Biochemical Relapse free Survival) and % free from PSA failure. This study also studied the side effects, complication and Quality of life after Brachytherapy.
Group and Methods: Localized prostate cancer patient in Phramongkutklao hospital for 78 patients, since December 2000 until October 2008 were categorized by DûAmico (1998) risk group to 3 groups. In low and Intermediate risk patients were treated mostly with Brachytherapy alone. In high risk group patients usually were treated by combination therapy which are external beam radiation and androgen deprivation therapy for a period of time.
Outcome: Longest follow up of the patient was almost 8 years and the average follow up time was 4.2 years. The results were satisfactory. BRFS by risk group:low, intermediate and high risk were 100%, 96% and 93.3% respectively. %Free from PSA failure by initial PSA: <10, 10-20, >20 were 93.8%, 92.3%, 84.8% respectively. The study showed that risk group affects the outcome significantly (P value=0.001) Most side effects were lower urinary tract symptoms which are controlled by medication but some (14% of severe LUTS patients) were needed to TUR-P. Serious complication, such as prostatorectal fistula was not seen.
Conclusion: Brachytherapy is the suitable choice of treatment in localized prostate cancer with satisfactory outcome and low side effects and complications. However this study is quite small and short term study when compared to the 15 years follow up study in US. But it is Perhaps the beginning of study in the outcome of Brachytherapy in Thailand. The Author hopes that there will be larger and more accurate study in Thailand.
References
Ahmedin Jemal., 2004. Ahmedin J, Ram C. Tiwari, et al: Cancer Statistics, 2004. CA Cancer J Clin 2004; 54:8
Quaranta et al., 2004. Quaranta BP, Marks LA, Anscher MS: Comparing radical prostatectomy and Brachytherapy for localized prostate cancer. Oncology 2004; 18: 1289-302.
Moul JW., 2002. Moul JW, Wu H, et al : Epidemiology of radical prostatectomy for localized prostate cancer in the era of prostate- specific antigen: an overview of the Department of Defense Center for Prostate Disease Research national database. Surgery, 2002 Aug; 132(2): 213-9.
Penner Schraudenbach., 2007. Penner S, Carlos E. Bermejo, et al: Management of the complications of radical prostatectomy. Current prostate reports 2007 Nov; 5(4): 153-8.
J. Rassweiler.,2002. Rassweiler, O. Seeman, et al: Laparoscopic Versus Open Radical Prostatectomy: A Comparative Study at a Single Institution. J Urol 2002; 169: 1689-1693.
B. Guillonneau.,2001.B. Guillonneau, F. Rozet, et al. Perioperative complications of laparoscopic Radical Prostatectomy: The Montsouris 3-year experience: J Urol 2001; 167(1):51-6.
H. Lepor.,2000. H. Lepor, A. Neider, et al. Intraoperative and Postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol 2000; 166(5): 1729-33.
Hedican and Walsh, 1994. Hedican SP, Walsh PC: Postoperative bleeding following radical retropubic prostatectomy. J Urol 1994; 152: 1181-3.
Ragde et al., 2001. Ragde H, Grado GL, Nadir BS: Brachytherapy for clinically localized prostate cancer: Thirteen-year disease-free survival of 769 consecutive prostate cancer patients treated with permanent implants alone. Arch Esp Urol 2001; 54: 739-47.
N. Stone.,2003. N. Stone,R. Stock, et al : Prospective assessment of patient-reported long-term urinary morbidity and associated quality of life changes after 125I prostate brachytherapy. Brachytherapy 2003; 2(1): 32-9.
Grado et al., 1998. Grado GL, Larson TR, Balch C, et al: Actuarial disease-free survival after prostate cancer Brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance. Int J Radiat Oncol Biol Phys 1998; 42: 289-98.
Blasko et al., 2002. Blasko JC, Mate T, Sylvester JE, et al: Brachytherapy for carcinoma of the prostate: Techniques, patient selection, and clinical outcomes. Semin Radiat Oncol 2002; 12: 81-94.
Sylvester et al., 2004. Sylvester JE, Blasko JC, Grimm R, et al: Fifteen year follow-up of the first cohort of localized prostate cancer treated with Brachytherapy. ASCO Abstract 2004; 4567.
Sylvester et al., 2003. Sylvester JE, Blasko JC, Grimm PD, et al: Ten-year biochemical relapse-free survival after external beam radiation and Brachytherapy for localized prostate cancer: The Seattle experience. Int J Radiat Oncol Biol Phys 2003; 57: 944-52.
, Quaranta et al., 2004. Quaranta BP, Marks LA, Anscher MS: Comparing radical prostatectomy and Brachytherapy for localized prostate cancer. Oncology 2004; 18: 1289-302.
DûAmico et al., 2003.DûAmico AV, Moul JW, Carroll PR, et al: Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst 2003; 95:1376-83.
Benoit et al., 2000b. Benoit R, Naslund MJ, Cohen J: Complications after prostate Brachytherapy in the Medicare population. Urology 2000; 55: 91-6.
DûAmico et al., 1998b. DûAmico AV, Whittington R, Malkowicz S, et al: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280: 969-74.
DûAmico et al., 2004b. DûAmico AV, Moul J, Carroll PR, et al: Prostate specific antigen doubling time as a surrogate end point for prostate cancer-specific mortality following radical prostatectomy or radiation therapy. J Urol 2004; 172(pt 2): S42-S46; discussion S46-S47.
Nag et al., 1999. Nag S, Beyer D, Friedland J, Grimm P, Nath R: American Brachytherapy Society (ABS) recommendations for transperineal permanent Brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 1999; 44: 789-99.
Stock et al., 2004. Stock RG, Cahlon O, Cesaretti JA, et al: Combined modality treatment in the management of high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2004; 59:1352-9.
, Stock and Stone, 2002. Stock RG, Stone NN: Preliminary toxicity and prostate-specific antigen response of a phase I/II trial of neoadjuvant hormonal therapy, 103Pd Brachytherapy, and three-dimensional conformal external beam irradiation in the treatment of locally advanced prostate cancer. Brachytherapy 2002; 1: 2-10.
Grimm et al., 2000. Grimm PD, Blasko JC, Sylvester JE, et al: Palladium-103 Brachytherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 2000; 46: 839-50.
Sandler et al., 2003. Sandler HM, Pajak TF, Hanks GE, et al: Can biochemical failure (ASTRO definition) be used as a surrogate endpoint for prostate cancer survival in phase III localized prostate cancer clinical trials? [abstract 1529]. Proc ASCO 2003; 22: 381.
Consensus statement, 1997. Consensus statement: Guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 1997; 37: 1035-41.
Theodorescu et al., 2000. Theodorescu D, Gillenwater JY, Koutrouvelis PG: Prostatourethral-rectal fistula after prostate Brachytherapy. Cancer 2000; 89: 2085-91.
Wolf et al., 1995. Wolf Jr JS, Cher M, Dallûera M, et al: The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol 1995; 153: 993.
