Permanent prostate brachytherapy monotherapy with I-125 for low- and intermediate-risk prostate cancer: Outcomes in 974 patients

David M. Routman, Ryan K. Funk, Bradley J. Stish, Lance A. Mynderse, Torrence M. Wilson, Robert McLaren, W. Scott Harmsen, Kristin Mara, Christopher L. Deufel, Keith M. Furutani, Michael G. Haddock, Thomas M. Pisansky, C. Richard Choo, Brian J Davis

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Purpose: To report outcomes of patients undergoing low-dose-rate (LDR) brachytherapy and investigate factors associated with biochemical failure and survival. Methods: Consecutive patients undergoing LDR with I-125 at our institution between 1998 through 2013 for primary intact prostate cancer were examined. Those with low- and intermediate-risk disease receiving LDR with a minimum of 2 years followup and at least one post-LDR prostate-specific antigen (PSA) were included. Results: About 974 patients satisfied inclusion criteria. With median followup of 72 months, biochemical failure occurred in 45 patients. Freedom from biochemical failure as defined by the Phoenix criterion was 96% and 88% at 5 and 10 years, worse for intermediate risk as compared with low risk, with 10-year freedom from biochemical failure of 76% versus 92% (hazard ratio [HR] = 3.7, p < 0.001), respectively. On multivariable analysis, increased prebiopsy PSA, Gleason 4 + 3, and no androgen deprivation therapy were associated with biochemical failure. Gleason 4 + 3 was the factor most strongly associated with biochemical failure (HR = 7.01, p < 0.001). No examined factors were associated with local failure. Gleason 4 + 3 disease increased the likelihood of distant metastasis (HR = 12.4, p = 0.003) and prostate cancer–specific death (HR = 13.2, p < 0.001). No difference in outcomes between patients with Gleason 3 + 3 versus 3 + 4 was observed. Conclusions: LDR brachytherapy provided excellent outcomes in this large series of patients treated for localized organ-confined prostate cancer. Local recurrence at 10 years was low at 2.1%. Primary Gleason 4 + 3, higher pretreatment PSA, and no receipt of androgen deprivation therapy were the only factors associated with biochemical failure. Primary Gleason 4 disease was also predictive of distant metastases and decreased prostate cancer–specific survival.

Original languageEnglish (US)
JournalBrachytherapy
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • ADT
  • Brachytherapy
  • LDR
  • Low-dose-rate
  • Prostate cancer
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Routman, D. M., Funk, R. K., Stish, B. J., Mynderse, L. A., Wilson, T. M., McLaren, R., Harmsen, W. S., Mara, K., Deufel, C. L., Furutani, K. M., Haddock, M. G., Pisansky, T. M., Choo, C. R., & Davis, B. J. (Accepted/In press). Permanent prostate brachytherapy monotherapy with I-125 for low- and intermediate-risk prostate cancer: Outcomes in 974 patients. Brachytherapy. https://doi.org/10.1016/j.brachy.2018.09.003