Yonsei Med J.  2013 Sep;54(5):1207-1213. 10.3349/ymj.2013.54.5.1207.

Outcomes of Gleason Score < or =8 among High Risk Prostate Cancer Treated with 125I Low Dose Rate Brachytherapy Based Multimodal Therapy

• Park DS
• Gong IH
• Choi DK
• Hwang JH
• Shin HS
• Oh JJ

• KMID: 1793169
• DOI: http://doi.org/10.3349/ymj.2013.54.5.1207

Abstract

PURPOSE
To investigate the role of low dose rate (LDR) brachytherapy-based multimodal therapy in high-risk prostate cancer (PCa) and analyze its optimal indications.
MATERIALS AND METHODS
We reviewed the records of 50 high-risk PCa patients [clinical stage > or =T2c, prostate-specific antigen (PSA) >20 ng/mL, or biopsy Gleason score > or =8] who had undergone 125I LDR brachytherapy since April 2007. We excluded those with a follow-up period <3 years. Biochemical recurrence (BCR) followed the Phoenix definition. BCR-free survival rates were compared between the patients with Gleason score > or =9 and Gleason score < or =8.
RESULTS
The mean initial PSA was 22.1 ng/mL, and mean D90 was 244.3 Gy. During a median follow-up of 39.2 months, biochemical control was obtained in 72% (36/50) of the total patients; The estimated 3-year BCR-free survival was 92% for the patients with biopsy Gleason scores < or =8, and 40% for those with Gleason scores > or =9 (p<0.001). In Cox multivariate analysis, only Gleason score > or =9 was observed to be significantly associated with BCR (p=0.021). Acute and late grade > or =3 toxicities were observed in 20% (10/50) and 36% (18/50) patients, respectively.
CONCLUSION
Our results showed that 125I LDR brachytherapy-based multimodal therapy in high-risk PCa produced encouraging relatively long-term results among the Asian population, especially in patients with Gleason score < or =8. Despite small number of subjects, biopsy Gleason score > or =9 was a significant predictor of BCR among high risk PCa patients after brachytherapy.

Keyword

Prostate cancer; brachytherapy; high risk group; biochemical recurrence

MeSH Terms

Aged
Combined Modality Therapy
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasm Grading
Prostatic Neoplasms/pathology/*radiotherapy
Radiation Dosage
Regression Analysis
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Kaplan Meier survival curve according to biopsy Gleason score among high-risk prostate cancer patients who underwent 125I low dose rate brachytherapy.

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