Salvage brachytherapy for localized prostate cancer after radiotherapy failure

Gordon L. Grado, Joseph M. Collins, J. Scott Kriegshauser, Carrie S. Balch, Mary M. Grado, Gregory P. Swanson, Thayne R. Larson, Mahlon M. Wilkes, Roberta J. Navickis

Research output: Contribution to journalArticle

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Abstract

Objectives. To evaluate the effectiveness and morbidity of salvage brachytherapy for locally recurrent or persistent prostate cancer after radiotherapy failure. Methods. In this retrospective study, 49 patients of median age 73.3 years (range 52.9 to 86.9) with biopsy-proven localized prostate cancer underwent interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy with either iodine 125 or palladium 103 after prior radiotherapy failure. Post-treatment follow-up was conducted for a median of 64.1 months (range 26.6 to 96.8) and included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels, and documentation of treatment-related symptoms and complications. Determination of biochemical treatment failure was based on two successive rising PSA values above the post-treatment PSA nadir value. Results. The actuarial rate of local prostate cancer control was 98% (95% confidence interval [CI] 94% to 99%). Actuarial disease-specific survival at 3 and 5 years was 89% (95% CI 73% to 96%) and 79% (95% CI 58% to 91%), respectively. At 3 and 5 years, actuarial biochemical disease-free survival was 48% (95% CI 32% to 63%) and 34% (95% CI 17% to 51%), respectively. Post-treatment PSA nadir was found to be a significant predictor of biochemical disease, free survival. Actuarial biochemical disease-free survival of patients who achieved a PSA nadir less than 0.5 ng/mL was 77% [95% CI 53% to 90%) and 56% (95% CI 25% to 78%) at 3 and 5 years, respectively. Of 49 patients, 23 (47%) achieved a post-treatment PSA nadir less than 0.5 ng/mL. The incidence of serious complications after salvage brachytherapy, such as incontinence and rectal complications, was lower than that reported after other types of salvage procedures. Conclusions. Interactive transperineal fluoroscopic- guided and biplane ultrasound-guided brachytherapy is a novel, potentially curative salvage modality for patients in whom prior radiotherapy failed. In a population of patients with poor prognosis, this modality was associated with a high rate of local prostate cancer control and a 34% actuarial rate of biochemical disease-free survival at 5 years. The incidence of major complications after salvage brachytherapy appears to be lower than that after other potentially curative salvage procedures, such as radical prostatectomy and cryoablation. Salvage brachytherapy warrants further investigation.

Original languageEnglish (US)
Pages (from-to)2-10
Number of pages9
JournalUrology
Volume53
Issue number1
DOIs
StatePublished - Jan 1999

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Brachytherapy
Prostate-Specific Antigen
Prostatic Neoplasms
Radiotherapy
Confidence Intervals
Disease-Free Survival
Therapeutics
Cryosurgery
Incidence
Palladium
Prostatectomy
Treatment Failure
Iodine
Documentation
Retrospective Studies
Morbidity
Biopsy
Survival
Serum
Population

ASJC Scopus subject areas

  • Urology

Cite this

Grado, G. L., Collins, J. M., Kriegshauser, J. S., Balch, C. S., Grado, M. M., Swanson, G. P., ... Navickis, R. J. (1999). Salvage brachytherapy for localized prostate cancer after radiotherapy failure. Urology, 53(1), 2-10. https://doi.org/10.1016/S0090-4295(98)00492-0

Salvage brachytherapy for localized prostate cancer after radiotherapy failure. / Grado, Gordon L.; Collins, Joseph M.; Kriegshauser, J. Scott; Balch, Carrie S.; Grado, Mary M.; Swanson, Gregory P.; Larson, Thayne R.; Wilkes, Mahlon M.; Navickis, Roberta J.

In: Urology, Vol. 53, No. 1, 01.1999, p. 2-10.

Research output: Contribution to journalArticle

Grado, GL, Collins, JM, Kriegshauser, JS, Balch, CS, Grado, MM, Swanson, GP, Larson, TR, Wilkes, MM & Navickis, RJ 1999, 'Salvage brachytherapy for localized prostate cancer after radiotherapy failure', Urology, vol. 53, no. 1, pp. 2-10. https://doi.org/10.1016/S0090-4295(98)00492-0
Grado GL, Collins JM, Kriegshauser JS, Balch CS, Grado MM, Swanson GP et al. Salvage brachytherapy for localized prostate cancer after radiotherapy failure. Urology. 1999 Jan;53(1):2-10. https://doi.org/10.1016/S0090-4295(98)00492-0
Grado, Gordon L. ; Collins, Joseph M. ; Kriegshauser, J. Scott ; Balch, Carrie S. ; Grado, Mary M. ; Swanson, Gregory P. ; Larson, Thayne R. ; Wilkes, Mahlon M. ; Navickis, Roberta J. / Salvage brachytherapy for localized prostate cancer after radiotherapy failure. In: Urology. 1999 ; Vol. 53, No. 1. pp. 2-10.
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abstract = "Objectives. To evaluate the effectiveness and morbidity of salvage brachytherapy for locally recurrent or persistent prostate cancer after radiotherapy failure. Methods. In this retrospective study, 49 patients of median age 73.3 years (range 52.9 to 86.9) with biopsy-proven localized prostate cancer underwent interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy with either iodine 125 or palladium 103 after prior radiotherapy failure. Post-treatment follow-up was conducted for a median of 64.1 months (range 26.6 to 96.8) and included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels, and documentation of treatment-related symptoms and complications. Determination of biochemical treatment failure was based on two successive rising PSA values above the post-treatment PSA nadir value. Results. The actuarial rate of local prostate cancer control was 98{\%} (95{\%} confidence interval [CI] 94{\%} to 99{\%}). Actuarial disease-specific survival at 3 and 5 years was 89{\%} (95{\%} CI 73{\%} to 96{\%}) and 79{\%} (95{\%} CI 58{\%} to 91{\%}), respectively. At 3 and 5 years, actuarial biochemical disease-free survival was 48{\%} (95{\%} CI 32{\%} to 63{\%}) and 34{\%} (95{\%} CI 17{\%} to 51{\%}), respectively. Post-treatment PSA nadir was found to be a significant predictor of biochemical disease, free survival. Actuarial biochemical disease-free survival of patients who achieved a PSA nadir less than 0.5 ng/mL was 77{\%} [95{\%} CI 53{\%} to 90{\%}) and 56{\%} (95{\%} CI 25{\%} to 78{\%}) at 3 and 5 years, respectively. Of 49 patients, 23 (47{\%}) achieved a post-treatment PSA nadir less than 0.5 ng/mL. The incidence of serious complications after salvage brachytherapy, such as incontinence and rectal complications, was lower than that reported after other types of salvage procedures. Conclusions. Interactive transperineal fluoroscopic- guided and biplane ultrasound-guided brachytherapy is a novel, potentially curative salvage modality for patients in whom prior radiotherapy failed. In a population of patients with poor prognosis, this modality was associated with a high rate of local prostate cancer control and a 34{\%} actuarial rate of biochemical disease-free survival at 5 years. The incidence of major complications after salvage brachytherapy appears to be lower than that after other potentially curative salvage procedures, such as radical prostatectomy and cryoablation. Salvage brachytherapy warrants further investigation.",
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AU - Grado, Gordon L.

AU - Collins, Joseph M.

AU - Kriegshauser, J. Scott

AU - Balch, Carrie S.

AU - Grado, Mary M.

AU - Swanson, Gregory P.

AU - Larson, Thayne R.

AU - Wilkes, Mahlon M.

AU - Navickis, Roberta J.

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N2 - Objectives. To evaluate the effectiveness and morbidity of salvage brachytherapy for locally recurrent or persistent prostate cancer after radiotherapy failure. Methods. In this retrospective study, 49 patients of median age 73.3 years (range 52.9 to 86.9) with biopsy-proven localized prostate cancer underwent interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy with either iodine 125 or palladium 103 after prior radiotherapy failure. Post-treatment follow-up was conducted for a median of 64.1 months (range 26.6 to 96.8) and included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels, and documentation of treatment-related symptoms and complications. Determination of biochemical treatment failure was based on two successive rising PSA values above the post-treatment PSA nadir value. Results. The actuarial rate of local prostate cancer control was 98% (95% confidence interval [CI] 94% to 99%). Actuarial disease-specific survival at 3 and 5 years was 89% (95% CI 73% to 96%) and 79% (95% CI 58% to 91%), respectively. At 3 and 5 years, actuarial biochemical disease-free survival was 48% (95% CI 32% to 63%) and 34% (95% CI 17% to 51%), respectively. Post-treatment PSA nadir was found to be a significant predictor of biochemical disease, free survival. Actuarial biochemical disease-free survival of patients who achieved a PSA nadir less than 0.5 ng/mL was 77% [95% CI 53% to 90%) and 56% (95% CI 25% to 78%) at 3 and 5 years, respectively. Of 49 patients, 23 (47%) achieved a post-treatment PSA nadir less than 0.5 ng/mL. The incidence of serious complications after salvage brachytherapy, such as incontinence and rectal complications, was lower than that reported after other types of salvage procedures. Conclusions. Interactive transperineal fluoroscopic- guided and biplane ultrasound-guided brachytherapy is a novel, potentially curative salvage modality for patients in whom prior radiotherapy failed. In a population of patients with poor prognosis, this modality was associated with a high rate of local prostate cancer control and a 34% actuarial rate of biochemical disease-free survival at 5 years. The incidence of major complications after salvage brachytherapy appears to be lower than that after other potentially curative salvage procedures, such as radical prostatectomy and cryoablation. Salvage brachytherapy warrants further investigation.

AB - Objectives. To evaluate the effectiveness and morbidity of salvage brachytherapy for locally recurrent or persistent prostate cancer after radiotherapy failure. Methods. In this retrospective study, 49 patients of median age 73.3 years (range 52.9 to 86.9) with biopsy-proven localized prostate cancer underwent interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy with either iodine 125 or palladium 103 after prior radiotherapy failure. Post-treatment follow-up was conducted for a median of 64.1 months (range 26.6 to 96.8) and included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels, and documentation of treatment-related symptoms and complications. Determination of biochemical treatment failure was based on two successive rising PSA values above the post-treatment PSA nadir value. Results. The actuarial rate of local prostate cancer control was 98% (95% confidence interval [CI] 94% to 99%). Actuarial disease-specific survival at 3 and 5 years was 89% (95% CI 73% to 96%) and 79% (95% CI 58% to 91%), respectively. At 3 and 5 years, actuarial biochemical disease-free survival was 48% (95% CI 32% to 63%) and 34% (95% CI 17% to 51%), respectively. Post-treatment PSA nadir was found to be a significant predictor of biochemical disease, free survival. Actuarial biochemical disease-free survival of patients who achieved a PSA nadir less than 0.5 ng/mL was 77% [95% CI 53% to 90%) and 56% (95% CI 25% to 78%) at 3 and 5 years, respectively. Of 49 patients, 23 (47%) achieved a post-treatment PSA nadir less than 0.5 ng/mL. The incidence of serious complications after salvage brachytherapy, such as incontinence and rectal complications, was lower than that reported after other types of salvage procedures. Conclusions. Interactive transperineal fluoroscopic- guided and biplane ultrasound-guided brachytherapy is a novel, potentially curative salvage modality for patients in whom prior radiotherapy failed. In a population of patients with poor prognosis, this modality was associated with a high rate of local prostate cancer control and a 34% actuarial rate of biochemical disease-free survival at 5 years. The incidence of major complications after salvage brachytherapy appears to be lower than that after other potentially curative salvage procedures, such as radical prostatectomy and cryoablation. Salvage brachytherapy warrants further investigation.

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