Long-Term Outcomes in Younger Men
Following Permanent Prostate Brachytherapy |
Edan Y. Shapiro, Soroush Rais-Bahrami, Carol Morgenstern, Barbara
Napolitano, Lee Richstone, Louis Potters
Purpose
We reviewed the long-term outcomes in men undergoing permanent prostate
brachytherapy with a focus on those presenting before age 60 years.
Materials and Methods
Between 1992 and 2005 a total of 2,119 patients with clinical stage
T1–T2, N0, M0 prostate cancer treated with permanent prostate
brachytherapy were included in this study. Treatment regimens consisted
of permanent prostate brachytherapy with or without hormone therapy,
permanent prostate brachytherapy with external beam radiotherapy, or all
3 modalities. Biochemical recurrence was defined using the Phoenix
definition. Multivariate analysis was performed to determine if age
and/or other clinicopathological features were associated with disease
progression. The Kaplan-Meier method was used to calculate rates of
freedom from progression with the log rank test to compare patients
younger than 60 versus 60 years or older.
Results
Median follow up was 56.1 months. In the study population 237 patients
were younger than 60 years at diagnosis (11%). The 5 and 10-year freedom
from progression rates were 90.1% and 85.6%, respectively, for the
entire population. Multivariate analysis demonstrated that prostate
specific antigen (p <0.01), biopsy Gleason score (p <0.0001) and year of
treatment (p <0.001) were associated with freedom from progression while
age (p = 0.95) and clinical stage (p = 0.11) were not. There was no
significant difference in freedom from progression between men younger
than 60, or 60 years or older (log rank p = 0.46). In the younger cohort
the 10-year freedom from progression for patients presenting with low,
intermediate and high risk disease was 91.3%, 80.0% and 70.2% compared
to 91.8%, 83.4% and 72.1%, respectively, for men 60 years or older.
Conclusions
Our long-term results confirm favorable outcomes after permanent
prostate brachytherapy in men younger than 60 years. Outcomes are
impacted by disease related risk factors but not by age or clinical
stage. Definitive treatment options for younger men with clinically
localized prostate cancer should include permanent prostate
brachytherapy.
a) The Arthur Smith Institute for Urology, North Shore-Long Island
Jewish Health System, New Hyde Park, New York
b) Department of Radiation Medicine, North Shore-Long Island Jewish
Health System, New Hyde Park, New York
c) Biostatistics Unit, Feinstein Institute for Medical Research, North
Shore-Long Island Jewish Health System, New Hyde Park, New York
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