BACKGROUND: The objective of this study was to determine whether the addition of low-dose-rate brachytherapy or androgen-deprivation therapy (ADT) improves clinical outcome in patients with high-risk prostate cancer (HiRPCa) who received dose-escalated radiotherapy (RT). METHODS: Between 1995 and 2010, 958 patients with HiRPCa were treated at Schiffler Cancer Center (n = 484) or at the University of Michigan (n = 474) by receiving either dose-escalated external-beam RT (EBRT) (n = 510; minimum prescription dose, 75 grays [Gy]; median dose, 78 Gy) or combined-modality RT (CMRT) consisting of (103) Pd implants (n = 369) or (125) I implants (n = 79) both with pelvic irradiation (median prescription dose, 45 Gy). The cumulative incidences of biochemical failure (BF) and prostate cancer-specific mortality (PCSM) were estimated by using the Kaplan-Meier method and Fine and Gray regression analysis. RESULTS: The median follow-up was 63.2 months (interquartile range, 35.4-99.0 months), and 250 patients were followed for >8 years. Compared with CMRT, patients who received EBRT had higher prostate-specific antigen levels, higher tumor classification, lower Gleason sum, and more frequent receipt of ADT for a longer duration. The 8-year incidence BF and PCSM among patients who received EBRT was 40% (standard error, 38%-44%) and 13% (standard error, 11%-15%) compared with 14% (standard error, 12%-16%; P < .0001) and 7% (standard error 6%-9%; P = .003) among patients who received CMRT. On multivariate analysis, the hazard ratios (HRs) for BF and PCSM were 0.35 (95% confidence interval [CI], 0.23-0.52; P < .0001) and 0.41 (95% CI, 0.23-0.75; P < .003), favoring CMRT. Increasing duration of ADT predicted decreased BF (P = .04) and PCSM (P = .001), which was greatest with long-term ADT (BF: HR, 0.33; P < .0001; 95% CI, 0.21-0.52; PCSM: HR, 0.30; P = .001; 95% CI, 0.15-0.6) even in the subgroup that received CMRT. CONCLUSIONS: In this retrospective comparison, both low-dose-rate brachytherapy boost and ADT were associated with decreased risks of BF and PCSM compared with EBRT.
BACKGROUND: The objective of this study was to determine whether the addition of low-dose-rate brachytherapy or androgen-deprivation therapy (ADT) improves clinical outcome in patients with high-risk prostate cancer (HiRPCa) who received dose-escalated radiotherapy (RT). METHODS: Between 1995 and 2010, 958 patients with HiRPCa were treated at Schiffler Cancer Center (n = 484) or at the University of Michigan (n = 474) by receiving either dose-escalated external-beam RT (EBRT) (n = 510; minimum prescription dose, 75 grays [Gy]; median dose, 78 Gy) or combined-modality RT (CMRT) consisting of (103) Pd implants (n = 369) or (125) I implants (n = 79) both with pelvic irradiation (median prescription dose, 45 Gy). The cumulative incidences of biochemical failure (BF) and prostate cancer-specific mortality (PCSM) were estimated by using the Kaplan-Meier method and Fine and Gray regression analysis. RESULTS: The median follow-up was 63.2 months (interquartile range, 35.4-99.0 months), and 250 patients were followed for >8 years. Compared with CMRT, patients who received EBRT had higher prostate-specific antigen levels, higher tumor classification, lower Gleason sum, and more frequent receipt of ADT for a longer duration. The 8-year incidence BF and PCSM among patients who received EBRT was 40% (standard error, 38%-44%) and 13% (standard error, 11%-15%) compared with 14% (standard error, 12%-16%; P < .0001) and 7% (standard error 6%-9%; P = .003) among patients who received CMRT. On multivariate analysis, the hazard ratios (HRs) for BF and PCSM were 0.35 (95% confidence interval [CI], 0.23-0.52; P < .0001) and 0.41 (95% CI, 0.23-0.75; P < .003), favoring CMRT. Increasing duration of ADT predicted decreased BF (P = .04) and PCSM (P = .001), which was greatest with long-term ADT (BF: HR, 0.33; P < .0001; 95% CI, 0.21-0.52; PCSM: HR, 0.30; P = .001; 95% CI, 0.15-0.6) even in the subgroup that received CMRT. CONCLUSIONS: In this retrospective comparison, both low-dose-rate brachytherapy boost and ADT were associated with decreased risks of BF and PCSM compared with EBRT.
Authors: Daniel A Hamstra; Stephanie L Pugh; Herbert Lepor; Seth A Rosenthal; Kenneth J Pienta; Leonard Gomella; Christopher Peters; David Paul D'Souza; Kenneth L Zeitzer; Christopher U Jones; William A Hall; Eric Horwitz; Thomas M Pisansky; Luis Souhami; Alan C Hartford; Michael Dominello; Felix Feng; Howard M Sandler Journal: Radiother Oncol Date: 2019-09-17 Impact factor: 6.280
Authors: Hira Lal Goel; Aejaz Sayeed; Michael Breen; Matthew J Zarif; David S Garlick; Irwin Leav; Roger J Davis; Thomas J Fitzgerald; Andrea Morrione; Chung-Cheng Hsieh; Qin Liu; Adam P Dicker; Dario C Altieri; Lucia R Languino Journal: J Cell Physiol Date: 2013-07 Impact factor: 6.384
Authors: Ima Paydar; Abigail Pepin; Robyn A Cyr; Joseph King; Thomas M Yung; Elizabeth G Bullock; Siyuan Lei; Andrew Satinsky; K William Harter; Simeng Suy; Anatoly Dritschilo; John H Lynch; Thomas P Kole; Sean P Collins Journal: Front Oncol Date: 2017-02-07 Impact factor: 6.244
Authors: Jörg S Zimmermann; Rudolf Osieka; Thorsten Bruns; Helge Hollberg; Bastian Wiechmann; Olaf Netzbandt; Jörg Sablotny; Michael Malade; Matthias Heitz; Fritz Bernhardt; Jörg Tiemann; Marc Wilkens; Tom Brüske; Utz Welker; Volker Heinemann; Petra Zimmermann; Salvador Fernandez de la Maza; Dietrich Pfeiffer; Prof Roland Tauber; Dorothea Thomas; Christos Moustakis Journal: J Contemp Brachytherapy Date: 2018-08-31
Authors: Finbar Slevin; Sree Lakshmi Rodda; Peter Bownes; Louise Murray; David Bottomley; Clare Wilkinson; Ese Adiotomre; Bashar Al-Qaisieh; Emma Dugdale; Oliver Hulson; Joshua Mason; Jonathan Smith; Ann M Henry Journal: Clin Transl Radiat Oncol Date: 2019-10-14
Authors: Al V Taira; Gregory S Merrick; Wayne M Butler; Robert W Galbreath; Ryan Fiano; Kent E Wallner; Edward Adamovich Journal: J Contemp Brachytherapy Date: 2013-12-03