(P069) Gleason 7 Prostate Adenocarcinoma Treated With High- or Low-Dose-Rate Brachytherapy: Impact of External Beam Radiotherapy and/or Androgen Deprivation Therapy

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

nPSA has been related to biochemical progression–free survival, freedom from metastasis, and death from prostate cancer. BT with either EBRT or HT achieves a lower PSA nadir. There was no difference in disease failure. Longer follow-up may be necessary to see differences in disease failure in this population.

Julian Johnson, MD, Charles Hsu, I-Chow Hsu, MD, Vivian K. Weinberg, PhD, Alexander Gottschalk, MD, PhD, Barby Pickett, MS, Mack Roach; University of California, San Francisco; Texas Oncology

PURPOSE: To determine the impact of hormone therapy (HT) and/or external beam radiotherapy (EBRT) on prostate-specific antigen (PSA) nadir (nPSA) in patients with Gleason score (GS) 3 + 4 or 4 + 3 prostate cancer treated with low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy (BT) at a single institution.

MATERIALS AND METHODS: A total of 148 men were retrospectively identified with GS 7 (21% GS4 + 3, 79% GS3 + 4) cT1–T2cN0 prostate cancer receiving LDR (76%) or HDR (24%) BT as a component of treatment. LDR or HDR monotherapy was administered to 29% (EBRT was administered in 58%; HT was administered to 51%). Median follow-up from BT until last PSA or death was 72 months (range: 1–141 mo). nPSA was defined as current postimplant PSA nadir as of last visit. Disease failure was defined as PSA failure, local recurrence, metastasis, or salvage therapy.

RESULTS: Median time to nPSA was 43.4 months vs 29.8 months for patients treated with LDR vs HDR (P = .03). Patients treated with HDR were more likely to have T2 disease (P = .01) and had higher median baseline PSA (8.6 vs 6.2 ng/mL; P = .004). Patients treated with HDR were more likely to receive HT (42% vs 69%; P = .01) but not EBRT (54% vs 61%; P = .56). There was no statistically significant difference between nPSA after LDR vs HDR (median: 0.1 vs 0.1 ng/mL; P = .27). Median nPSA after LDR for GS 3 + 4 vs 4 + 3 was 0.1 ng/mL and 0.05 ng/mL, respectively (P = .32). Median nPSA after HDR for GS 3 + 4 vs GS 4 + 3 was 0.1 vs 0.06 ng/mL, respectively (P = .62). Treatment with HT resulted in a median nPSA of 0.045 vs 0.1 ng/mL (P < .0001). EBRT resulted in median nPSA of 0.06 ng/mL vs 0.1 ng/mL (P = .05). Patients treated with LDR brachytherapy had a lower nPSA if treated with HT (0.05 ng/mL vs 0.1 ng/mL; P = .0002). HT did not result in a lower nPSA in patients treated with HDR (P = .18). There was a statistically significant lower nPSA among LDR patients when combined with EBRT vs no EBRT (0.05 ng/mL vs 0.1 ng/mL; P = .003) but not among HDR patients (P = .52). Freedom from disease failure rate at 5 years was 92% vs 94% for LDR vs HDR, respectively (P = .00). There was no statistically significant difference with ADT (95% vs 89%; P = .33) or with EBRT (93% vs 91%; P = .37).

CONCLUSIONS: nPSA has been related to biochemical progression–free survival, freedom from metastasis, and death from prostate cancer. BT with either EBRT or HT achieves a lower PSA nadir. There was no difference in disease failure. Longer follow-up may be necessary to see differences in disease failure in this population.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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