Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

The role of external radiotherapy in patients treated with permanent prostate brachytherapy

Role for combined radiotherapy and brachytherapy in prostate cancer L Potterset al

Prostate Cancer and Prostatic Diseases volume 5, pages 47–53 (2002)Cite this article

Abstract

To examine the difference in Prostate Specific Antigen (PSA)-Relapse Free Survival (RFS) in patients (pts) with prostate cancer treated with permanent prostate brachytherapy (PPB) alone (monotherapy) or combined modality PPB and external radiotherapy (CMT) by a matched pair analysis. There were 1476 pts who were treated loosely based on the American Brachytherapy Society criteria for monotherapy or CMT. PSA-RFS was based upon the Kattan modification of the ASTRO consensus panel definition. A computer generated matching process was undertaken to produce two equally weighted pairs of patients divided by treatment methodology and Kaplan-Meier PSA-RFS curves were generated and compared by χ2 testing. All pts were treated between 1992 and 2000 with a 6-y PSA-RFS of 81.9%. The median follow-up was 34.7 months. Patients treated with CMT presented with higher pre-treatment PSA values, Gleason sum score, clinical stage, risk classification, and were more likely to be treated with neoadjuvant hormones. A matched-pair analysis with 314 pts in each group was created stratified by the addition of neoadjuvant hormones, Gleason score sum and the pretreatment PSA value. Actuarial 5-y PSA-RFS was 77.0% for the monotherapy group and 81.1% for the combined therapy group (P=0.54).

χ2 testing by pretreatment PSA value, Gleason score sum, risk stratification, isotope and the addition of neoadjuvant hormones failed to identify any group with a significant difference in 5-y PSA-RFS. In conclusion, this retrospective study presents a large cohort of patients treated with PPB that failed to identify a significant advantage for the addition of combined therapy. A matched pair analysis performed also failed to identify any significant difference based on treatment modality.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Potters L. . Permanent prostate brachytherapy: lessons learned, lessons to learn. Oncology (Huntingt) 2000 14: 981–991.

    CAS  Google Scholar 

  2. Grado GL et al. Actuarial disease-free survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance. Int J Radiat Oncol Biol Phys 1998 42: 289–298.

    Article  CAS  Google Scholar 

  3. Dattoli M et al. 103Pd brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma. Int J Radiat Oncol Biol Phys 1996 35: 875–879.

    Article  CAS  Google Scholar 

  4. Beyer DC, Priestley JB Jr. . Biochemical disease-free survival following 125I prostate implantation. Int J Radiat Oncol Biol Phys 1997 37: 559–563.

    Article  CAS  Google Scholar 

  5. Stokes SH et al. Transperineal ultrasound-guided radioactive seed implantation for organ-confined carcinoma of the prstate. Int J Radiat Oncol Biol Phys 1997 37: 337–341.

    Article  CAS  Google Scholar 

  6. Ragde H et al. Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high Gleason grade prostate carcinoma. Cancer 1998 83: 989–1001.

    Article  CAS  Google Scholar 

  7. Stock RG et al. Prostate specific antigen findings and biopsy results following interactive ultrasound guided transperineal brachytherapy for early stage prostate carcinoma. Cancer 1996 77: 2386–2392.

    Article  CAS  Google Scholar 

  8. Nag S et al. American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 1999 44: 789–799.

    Article  CAS  Google Scholar 

  9. Critz FA et al. Simultaneous irradiation for prostate cancer: intermediate results with modern techniques. J Urol 2000 164: 738–741.

    Article  CAS  Google Scholar 

  10. Potters L et al. The role of external beam irradiation in patients undergoing prostate brachytherapy. Uro Oncology 2000 5: 112–117.

    Article  CAS  Google Scholar 

  11. Fleming ID et al. AJCC Cancer Staging Manual, Philadelphia, Pensylvania, Fifth Edition. Lippincitt-Raven 1997

  12. Beyer D et al. American Brachytherapy Society recommendations for clinical implementation of NIST-1999 standards for (103)palladium brachytherapy. Int J Radiat Oncol Biol Phys 2000 47: 273–275.

    Article  CAS  Google Scholar 

  13. Nath R et al. Correlation of medical dosimetry quality indicators to the local tumor control in patients with prostate cancer treated with iodine-125 interstitial implants. Med Phys 1998 25: 2293–2307.

    Article  CAS  Google Scholar 

  14. Stone NN, Stock RG. . Brachytherapy for prostate cancer: real-time three-dimensional interactive seed implantation. Tech Urol 1995 1: 72–80.

    CAS  Google Scholar 

  15. Consensus statement: guidelines for PSA following radiation therapy. American Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys 1997 37: 1035–1041.

  16. Kattan MW, Fearn PA, Leibel S, Potters L. . The definition of biochemical failure in patients treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys 2000 48: 1469–1474.

    Article  CAS  Google Scholar 

  17. Cox DR, Abadir R. . Regression models and life tables. J Roy Statist Soc 1972 34: 187–220.

    Google Scholar 

  18. Kaplan EL, Meier P. . Nonparametric estimation from incomplete observations. J Cancer Res Clin Oncol 1958 53: 457–816.

    Google Scholar 

  19. Partin AW et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 1997 277: 1445–1451.

    Article  CAS  Google Scholar 

  20. Davis BJ et al. The radial distatnce of extraprostatic extension of prostate adenocarcimoma: Implications for prostate brachytherapy. Int J Radiat Oncol Biol Phys 1998 42: 132–132.

    Article  Google Scholar 

  21. Ragde H et al. Modern prostate brachytherapy. Prostate specific antigen results in 219 patients with up to 12 y of observed follow-up. Cancer 2000 89: 135–141.

    Article  CAS  Google Scholar 

  22. Blasko JC, Grimm PD, Sylsvester JE, Cavanagh W. . The role of external beam radiotherapy with I-125/Pd-103 brachytherapy for prostate carcinoma. Radiother Oncol 2000 57: 273–278.

    Article  CAS  Google Scholar 

  23. Zelefsky MJ et al. Postimplantation dosimetric analysis of permanent transperineal prostate implantation: improved dose distributions with an intraoperative computer-optimized conformal planning technique. Int J Radiat Oncol Biol Phys 2000 48: 601–608.

    Article  CAS  Google Scholar 

  24. Vicini FA, Kestin LL, Martinez AA. . The importance of adequate follow-up in defining treatment success after external beam irradiation for prostate cancer. Int J Radiat Oncol Biol Phys 1999 45: 553–561.

    Article  CAS  Google Scholar 

  25. Gelblum DY, Potters L. . Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2000 48: 119–124.

    Article  CAS  Google Scholar 

  26. Gelblum D et al. Urinary morbidity following ultrasound-guided transperineal prostate seed implantation. Int J Radiat Oncol Biol Phys 1999 45: 59–67.

    Article  CAS  Google Scholar 

  27. Zeitlin SI et al. High dose combination radiotherapy for the treatment of localized prostate cancer. J Urol 1998 160: 91–95.

    Article  CAS  Google Scholar 

  28. Brandeis JM, Litwin MS, Burnison CM, Reiter RE. . Quality of life outcomes after brachytherapy for early stage prostate cancer. J Urol 2000 163: 851–857.

    Article  CAS  Google Scholar 

  29. Gallagher PE, Klemp T, Smith SL . Medicare RBRVS: The Physician's Guide Fifth edn. American Medical Association: Chicago 2001

  30. Dattoli M et al. Prognostic role of serum prostatic acid phosphatase for 103Pd-based radiation for prostatic carcinoma [In Process Citation]. Int J Radiat Oncol Biol Phys 1999 45: 853–856.

    Article  CAS  Google Scholar 

  31. Zelefsky MJ et al. Five-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 2000 47: 1261–1266.

    Article  CAS  Google Scholar 

  32. Lederman GS et al. Retrospective stratification of a consecutive cohort of prostate cancer patients treated with a combined regimen of external-beam radiotherapy and brachytherapy. Int J Radiat Oncol Biol Phys 2001 49: 1297–1303.

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Poster Presentation, American Urologic Association Meeting, Anaheim, CA, June 2001

Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center at Mercy Medical Center, Rockville Centre, NY, USA

    L Potters

  2. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    P Fearn & M Kattan

Authors
  1. L Potters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P Fearn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Kattan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L Potters.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Potters, L., Fearn, P. & Kattan, M. The role of external radiotherapy in patients treated with permanent prostate brachytherapy. Prostate Cancer Prostatic Dis 5, 47–53 (2002). https://doi.org/10.1038/sj.pcan.4500552

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.pcan.4500552

Keywords

Search

Advanced search

Quick links