Combined modality treatment in the management of high-risk prostate cancer

The efficacy of a multimodality protocol using neoadjuvant and concomitant hormonal therapy, brachytherapy, and three-dimensional conformal external beam radiotherapy (RT) in high-risk prostate cancer was evaluated using biochemical outcomes and posttreatment biopsy results. Between February 1994 an...

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Bibliographic Details
Published in:International journal of radiation oncology, biology, physics Vol. 59; no. 5; p. 1352
Main Authors: Stock, Richard G, Cahlon, Oren, Cesaretti, Jamie A, Kollmeier, Marisa A, Stone, Nelson N
Format: Journal Article
Language:English
Published: United States 01.08.2004
Subjects:
Androgen Antagonists - therapeutic use
Antineoplastic Agents, Hormonal - therapeutic use
Brachytherapy
Combined Modality Therapy
Finasteride - therapeutic use
Flutamide - therapeutic use
Gonadotropin-Releasing Hormone - agonists
Humans
Male
Palladium - therapeutic use
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood
Prostatic Neoplasms - drug therapy
Prostatic Neoplasms - radiotherapy
Radioisotopes - therapeutic use
Radiotherapy, Conformal
Testosterone - blood
ISSN:0360-3016
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Summary:The efficacy of a multimodality protocol using neoadjuvant and concomitant hormonal therapy, brachytherapy, and three-dimensional conformal external beam radiotherapy (RT) in high-risk prostate cancer was evaluated using biochemical outcomes and posttreatment biopsy results. Between February 1994 and November 1999, 132 high-risk patients were treated with combined hormonal therapy (9 months), permanent radioactive seed brachytherapy, and external beam RT, with follow-up ranging from 36 to 88 months (median, 50 months). The eligibility criteria were any of the following: Gleason score 8-10, initial prostate-specific antigen (PSA) level >20 ng/mL, clinical Stage T2c-T3, or positive seminal vesicle biopsy, or two or more of the following: Gleason score 7, PSA level >10-20 ng/mL, or Stage T2b. Twenty percent of patients had a positive seminal vesicle biopsy before therapy. Negative laparoscopic pelvic lymph node dissections were performed in 44% of patients. The actuarial overall freedom from PSA failure rate was 86% at 5 years. The freedom from PSA failure rate at 5 years was 97% for those with a Gleason score of < or =6 (35 of 36), 85% for a Gleason score of 7 (50 of 59), and 76% for a Gleason score of 8-10 (28 of 37; p = 0.03). A trend was noted toward worse outcomes in seminal vesicle biopsy-positive patients, with a 5-year freedom from PSA failure rate of 74% vs. 89% for all other patients (p = 0.06). Posttreatment prostate biopsies were performed in 47 patients and were negative in 96% at the first biopsy and 100% at the last biopsy. Trimodality therapy with androgen suppression, brachytherapy, and external beam RT for high-risk prostate cancer results in excellent biochemical and pathologically confirmed local control.
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ISSN:0360-3016
DOI:10.1016/j.ijrobp.2004.01.023