Young age is commonly viewed as a negative prognostic factor in prostate cancer. Data supporting this perception is scant. Our goal was to ascertain 5-year biochemical outcomes in young men treated with low-dose rate prostate brachytherapy.
Materials/Methods
1763 patients with clinically localized prostate cancer were treated with low-dose rate brachytherapy between 1990 to 2005 and had ≥2 years of follow-up. Patients were stratified into three groups based on age: ≤60 (n = 400), 61–75 (n = 1,142), and >75 (n = 221). Median follow-up for patients ≤60, 61–75 and >75 was 59 months (range 24–167), 62 months (range 24–181) and 54 months (range 24–197), respectively. Biochemical failure was defined by the ASTRO consensus definition. Univariate and multivariate Cox regression analyses were used to determine if any variable was predictive of 5-year bFFF. Variables included risk group (low vs. intermediate vs. high), Gleason score (≤6 vs. 7 vs. ≥8), pretreatment prostate-specific antigen (PSA) (<10 vs. 10–20 vs >20), treatment type (implant ± hormones vs. implant and EBRT vs. trimodality), stage (≤T2a vs. T2b vs. ≥T2c), treatment era (1990–1997 vs. 1998–2005), use of hormonal therapy and biologically effective dose (BED ≤ 150 vs. >150). A two-sided p-value <0.05 was considered significant. Group comparisons were performed by Chi-square analysis.
Results
For the entire group, the actuarial 5-year bFFF was 90%. On univariate analysis, patients ≤60 years old demonstrated improved 5-year biochemical control rates at 96% vs. patients in the 61–75 and >75 year old age groups at 89% and 88%, respectively (p = 0.001). Compared to patients >60 years old, a significantly higher proportion of younger patients presented with low risk disease (57.3% vs 39.6%, p < .001), were treated after 1997 (72.3% vs 60.1%, p < .001), received hormonal therapy (60.2% vs. 57.5%, p150 (92.5% vs 85.2%, p < .001). On multivariate analysis of the entire group, treatment era (p = −0.009) and BED (p = 0.001) were significant in predicting 5-year biochemical control, but age was not (p = 0.2).
Conclusions
Young men achieve excellent 5-year biochemical control rates comparable to men >60 years old after prostate brachytherapy. Young age should not be a deterrant when considering brachytherapy as a primary treatment option.
Mount Sinai Medical Center, New York, NY
Author Disclosure: A.Y. Ho, None; G. Fan, None; J. Cesaretti, None; N. Stone, None; R. Stock, None.
FULL TEXT