Young Men Have Equivalent Biochemical Outcomes Compared With Older Men After Treatment With Brachytherapy for Prostate Cancer
Received 22 May 2009; received in revised form 22 June 2009; accepted 24 June 2009. published online 30 December 2009.
Purpose
To evaluate retrospectively the biochemical outcomes of young men treated with low-dose-rate brachytherapy for prostate cancer.
Methods and Materials
From 1990 to 2005, 1,665 men with clinically localized prostate cancer were treated with low-dose-rate brachytherapy ± hormone therapy (HT) ± external beam radiotherapy and underwent ≥2 years of follow-up. Patients were stratified on the basis of age: ≤60 (n = 378) and >60 years (n = 1,287). Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/mL. Univariate and multivariate analyses were used to determine the association of variables with freedom from biochemical failure (FFbF).
Results
Median follow-up was 68 months (range, 24–180) for men ≤60 years and 66 months (range, 24–200) for men >60. For the entire group, the actuarial 5- and 8-year FFbF rates were 94% and 88%, respectively. Men ≤60 demonstrated similar 5- and 8-year FFbF (95% and 92%) compared with men >60 (93% and 87%; p = 0.071). A larger percent of young patients presented with low-risk disease; lower clinical stage, Gleason score (GS), and pretreatment PSA values; were treated after 1997; did not receive any HT; and had a high biologic effective dose (BED) of radiation (all ps <0.001). On multivariate analysis, PSA (p = 0.001), GS (p = 0.005), and BED (p < 0.001) were significantly associated with FFbF, but age was not (p = 0.665).
Conclusion
Young men achieve excellent 5- and 8-year biochemical control rates that are comparable to those of older men after prostate brachytherapy. Young age should not be a deterrent when considering brachytherapy as a primary treatment option for clinically localized prostate cancer.
Reprint requests to: Richard G. Stock, M.D., Department of Radiation Oncology, Box 1236, 1 Gustave L. Levy Place, New York, NY 10029. Tel: (212) 241-7500; Fax: (212) 410-7194
Conflict of interest: J. A. Cesaretti is a consultant to C.R. Bard. N. N. Stone is owner of Prologics LLC and a consultant to Nihan Medi-Physics and B & K Medical. The other authors report no conflicts of interest.
ABSTRACT