Prospective phase II trial of permanent seed implantation prostate brachytherapy for intermediate-risk localized prostate cancer: efficacy, toxicity, and quality of life outcomes

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Steven J. Frank, Thomas J. Pugh, Pierre Blanchard, Usama Mahmood, William J. Graber, Rajat J. Kudchadker, John W. Davis, Jeri Kim, Haesun Choi, Patricia Troncoso, Deborah A. Kuban, Seungtaek Choi, Sean McGuire, Karen E. Hoffman, Hsiang-Chun Chen, Xuemei Wang, David A. Swanson
BackgroundBrachytherapy monotherapy is a treatment option for intermediate-risk localized prostate cancer but published prospective data are scarce.MethodsProspective phase II trial of 300 patients with previously untreated prostate cancer treated between 2006–2013. Eligible patients had ≤cT2b (T3 excluded based on magnetic resonance imaging), Gleason score [GS]=6 and prostate-specific antigen [PSA] level 10-15 ng/mL, or GS=7 and PSA<10 ng/mL, and were treated with prostate brachytherapy (without hormonal therapy).ResultsMedian patient age was 64.9 years; 3.7% had GS 6, 78.7% had GS 7(3+4), and 17.7% had GS 7(4+3). Median follow-up time was 5.1 years. Median PSA at 5 years was 0.01 ng/mL (range 0–6.0). Ten biochemical failures occurred, for a 5-year freedom from biochemical failure rate of 97.3% (95% confidence interval [CI] 95.1%, 99.5%), and 16 patients died, only one from prostate cancer, for 5-year rates of overall and biochemical progression-free survival of 94.9% (95% CI 92.1%, 97.9%) and 92.7% (95% CI 89.3%, 96.2%). Four patients had late grade 3 genitourinary toxicity and two late grade 3 rectal toxicity; no grade 4 or 5 toxicity was observed. Rates of "moderate or big problems" at 4 years were 7.4% for urinary (vs. 0.4% baseline), 2.9% bowel (vs. 0.4%), and 29.7% sexual function (vs. 19.7%). Most men were "satisfied or extremely satisfied" (91% at 2 years after treatment and 93% at 4 years).ConclusionsBrachytherapy monotherapy is safe, effective, and leads to good quality of life for select men with localized intermediate-risk prostate cancer.

Teaser

We report efficacy, toxicity and quality of life after prostate brachytherapy monotherapy for favorable intermediate risk cancer.Out of 300 patients, after a median follow-up of 5.1 years, only 10 recurrences were reported, yielding a 5-year freedom from biochemical failure rate of 97.3% and a 5-year biochemical progression-free survival rate of 94.9%.Four patients had late grade 3 genitourinary toxicity and two late grade 3 rectal toxicity; no grade 4 or 5 toxicity was observed.


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