UroToday.com – In the online edition of the BJU International, Dr. Richard Stock and colleagues from Mt. Sinai School of Medicine in New York reported on their outcomes using combined radiotherapy approach to men with high-risk prostate cancer (CaP).

The study cohort include 181 men with Gleason score 8-10 CaP treated with androgen deprivation therapy (ADT), brachytherapy, and external beam radiotherapy (ERBT) in combination between 1994 and 2006. The study is non-randomized, single institution and retrospective. The ADT was for 3 months followed by brachytherapy and then 2 months later concomitant ADT and ERBT were delivered. The total ADT duration was 9 months. 103Pd was the isotope for all brachytherapy and most men received a dose of 100Gy with 45Gy ERBT. Median follow-up was 65 months and the Phoenix definition of PSA recurrence was used.

The overall 8-year actuarial freedom from biochemical failure was 73%. In 36 patients with a biochemical relapse, the median time to PSA failure was 33 months with 53% failing within 3 years. The median PSADT was 2.7 months. Metastatic CaP developed in 22 patients and the 8-year freedom from distant metastases rate was 80%. The cancer-specific survival and overall survival at 8 years were 87% and 79%, respectively. In men experiencing PSA relapse, the 8-year CSS and overall survival were 53% and 51%, respectively. In multivariable analysis, only Gleason score and initial PSA significantly affected the development of biochemical failure. Toxicity from this treatment approach was not reported.

Stock RG, Cesaretti JA, Hall SJ, Stone NN
BJU Int. 2009 Jun 2. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.08661.x

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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