Permanent prostate brachytherapy monotherapy with I-125 for low- and intermediate-risk prostate cancer: Outcomes in 974 patients.

Autor:	Routman DM; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Funk RK; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Stish BJ; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Mynderse LA; Department of Urology, Mayo Clinic, Rochester, MN., Wilson TM; Department of Urology, Mayo Clinic, Rochester, MN., McLaren R; Department of Urology, Mayo Clinic, Rochester, MN., Harmsen WS; Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN., Mara K; Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN., Deufel CL; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Furutani KM; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Haddock MG; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Pisansky TM; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Choo CR; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Davis BJ; Department of Radiation Oncology, Mayo Clinic, Rochester, MN. Electronic address: Davis.Brian@mayo.edu.
Jazyk:	angličtina
Zdroj:	Brachytherapy [Brachytherapy] 2019 Jan - Feb; Vol. 18 (1), pp. 1-7. Date of Electronic Publication: 2018 Oct 04.
DOI:	10.1016/j.brachy.2018.09.003
Abstrakt:	Purpose: To report outcomes of patients undergoing low-dose-rate (LDR) brachytherapy and investigate factors associated with biochemical failure and survival. Methods: Consecutive patients undergoing LDR with I-125 at our institution between 1998 through 2013 for primary intact prostate cancer were examined. Those with low- and intermediate-risk disease receiving LDR with a minimum of 2 years followup and at least one post-LDR prostate-specific antigen (PSA) were included. Results: About 974 patients satisfied inclusion criteria. With median followup of 72 months, biochemical failure occurred in 45 patients. Freedom from biochemical failure as defined by the Phoenix criterion was 96% and 88% at 5 and 10 years, worse for intermediate risk as compared with low risk, with 10-year freedom from biochemical failure of 76% versus 92% (hazard ratio [HR] = 3.7, p < 0.001), respectively. On multivariable analysis, increased prebiopsy PSA, Gleason 4 + 3, and no androgen deprivation therapy were associated with biochemical failure. Gleason 4 + 3 was the factor most strongly associated with biochemical failure (HR = 7.01, p < 0.001). No examined factors were associated with local failure. Gleason 4 + 3 disease increased the likelihood of distant metastasis (HR = 12.4, p = 0.003) and prostate cancer-specific death (HR = 13.2, p < 0.001). No difference in outcomes between patients with Gleason 3 + 3 versus 3 + 4 was observed. Conclusions: LDR brachytherapy provided excellent outcomes in this large series of patients treated for localized organ-confined prostate cancer. Local recurrence at 10 years was low at 2.1%. Primary Gleason 4 + 3, higher pretreatment PSA, and no receipt of androgen deprivation therapy were the only factors associated with biochemical failure. Primary Gleason 4 disease was also predictive of distant metastases and decreased prostate cancer-specific survival. (Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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