High Dose Rate Brachytherapy as a Boost for the Treatment of Localized Prostate Cancer

Purpose

We report the outcome and toxicities of high dose rate brachytherapy as a boost for localized prostate cancer.

Materials and Methods

Between 1996 and 2003, 309 patients with prostate carcinoma were treated with external beam radiation therapy and high dose rate brachytherapy. Furthermore, 36% of the patients received neoadjuvant/concurrent or adjuvant androgen deprivation therapy. Patients were stratified into 3 groups. Group 1 of 67 patients had Gleason score 6 or less, pretreatment prostate specific antigen 10 ng/ml or less and clinical stage T2a or less. Group 2 of 109 patients had Gleason score 7 or greater, pretreatment prostate specific antigen greater than 10 ng/ml and clinical stage T2b or greater. Group 3 of 133 patients had 2 or more of these higher risk factors.

Results

At a median followup of 59 months the 5-year biochemical control rate, as defined by the American Society for Therapeutic Radiation and Oncology, was 86%, cause specific survival was 98% and overall survival was 91%. Biochemical control in stratified groups 1 to 3 was 98%, 90% and 78%, respectively. On univariate analysis risk group, pretreatment prostate specific antigen and Gleason score were significant predictors of biochemical control. However, on multivariate analysis only risk group and pretreatment prostate specific antigen were significant. Using the Common Toxicity Criteria scale there were 2 cases of grade 3 acute urinary toxicity. Regarding late side effects 4% of patients had grade 3 genitourinary toxicity and 1 had a grade 4 rectal complication.

Conclusions

External beam radiation therapy and high dose rate brachytherapy for prostate cancer resulted in excellent biochemical control, cause specific survival and overall survival with minimal severe acute or late complications.

Key Words: prostate, prostatic neoplasms, brachytherapy, radiotherapy, toxicity

Abbreviations and Acronyms: ADT, androgen deprivation therapy, BC, biochemical control, BT, brachytherapy, CSS, cause specific survival, CT, computerized tomography, CTC, Common Toxicity Criteria, EBRT, external beam radiation therapy, ED, erectile dysfunction, GI, gastrointestinal, GS, Gleason score, GU, genitourinary, HDR-BT, high dose rate BT, KWS, Kiel University, William Beaumont and Seattle Prostate Institute, LBMCC, Long Beach Memorial Cancer Center, OS, overall survival, prePSA, pretreatment PSA, PSA, prostatic specific antigen