Outcomes of T3a Prostate Cancer with Unfavorable Prognostic Factors Treated with Brachytherapy Combined with External Radiotherapy and Hormone Therapy.

OBJECTIVE: To evaluate the outcomes of T3a prostate cancer with unfavorable prognostic factors treated with permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy. METHODS: From January 2003 to December 2008, 38 patients classified as T3a prostate cancer with unfavorable prognostic factors were treated with trimodality therapy (brachytherapy + external radiotherapy + hormone therapy). The prescription dose of brachytherapy and external radiotherapy were 110 Gy and 45 Gy, respectively. The duration of hormone therapy was 2-3 years. The endpoints of this study included biochemical failure-free survival (BFFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS). Survival curves were calculated using the Kaplan-Meier method. The Log-rank test was used to identify the prognostic predictors for univariate analysis. RESULTS: The median follow-up was 71 months. The serum pre-treatment prostate-specific antigen (PSA) level ranged from 10.0 to 99.8 ng/ml (mean 56.3 ng/ml), the Gleason score ranged from 5 to 9 (median 8), and the percentage of positive biopsy cores ranged from 10% to 100% (mean 65%). The 5-year BFFS, DMFS, CSS, and OS rates were 44%, 69%, 82%, and 76%, respectively. All biochemical failures occurred within 40 months. The percentage of positive biopsy cores was significantly correlated with BFFS, DMFS, and OS (all P=0.000), and the Gleason score with DMFS (P=0.000) and OS (P=0.001). CONCLUSIONS: T3a prostate cancer with unfavorable prognostic factors presents not so optimistic outcome. Hormone therapy should be applied to prolong the biochemical progression-free or metastasis-free survival. The percentage of positive biopsy cores and the Gleason score are significant prognostic factors.

Clinical Characteristics and Outcome of Gleason Score 10 Prostate Cancer on Core Biopsy Treated by External Radiotherapy and Hormone Therapy.

OBJECTIVE: To evaluate the clinical characteristics and outcomes of patients with Gleason score 10 prostate cancer treated by external radiotherapy and hormone therapy. METHODS: From January 2003 to March 2014, 1832 patients with prostate cancer were treated, among which 9 patients (represented 0.49%) were identified as Gleason score 10 disease on prostate core biopsy without distant metastases when first diagnosed. All 9 patients were treated by whole pelvic external radiotherapy (The whole pelvic dose was 50.0 Gy and the boost dose ranged from 76.2 to 78.0 Gy) and long-term hormone therapy. We assessed the clinical characteristics, treatment outcomes and treatment toxicities. Survival curves were calculated using the Kaplan-Meier method. RESULTS: The median follow-up was 4.8 years. Six patients' pre-treatment prostate-specific antigen (PSA) levels were lower than 20.0 µg/L and three patients' pre-treatment PSA levels were higher than 70.0 µg/L. The median percentage of positive biopsy cores was 91%. Three, four and two cases were classified as T2c, T3a and T3b stage, respectively. Three cases were assessed as N1 stage. The 5-year biochemical failure-free survival, distant metastasis-free survival, cancer specific survival and overall survival rates were 28.6%, 57.1%, 66.7% and 57.1%, respectively. Five patients experienced grade 1-2 acute gastrointestinal toxicities and six patients complained of grade 1-2 acute genitourinary toxicities. No bone fracture or cardiovascular disease was detected. CONCLUSIONS: Gleason score 10 prostate cancer on core biopsy is usually combined with other high risk factors. The pre-treatment PSA levels lie in two extremes. Timely and active treatments are urgent needed because unfavourable oncological outcomes are often presented.

Long-term outcome of high-risk prostate cancer treated with brachytherapy combined with external-beam radiation therapy and androgen deprivation therapy.

AIMS AND BACKGROUND: To evaluate long-term outcome and biochemical progression-free survival (bPFS) in high-risk prostate cancer patients treated with brachytherapy combined with external-beam radiation therapy (EBRT) and androgen deprivation therapy (ADT). METHODS AND STUDY DESIGN: We retrospectively analyzed 97 high-risk prostate cancer patients treated with brachytherapy combined with EBRT and ADT. During follow-up, the post-operation prostate-specific antigen (PSA) level was monitored regularly and biochemical relapse, progression to castration-resistant prostate cancer or metastases, and causes of death were documented. We evaluated bPFS, cause-specific survival (CSS) and overall survival (OS). RESULTS: The bPFS, CSS and OS of the patients were 81.4%, 88.7% and 81.4%, respectively. The bPFS of the subcategories of patients stratified based on the presence or absence of a Gleason pattern 5 were 55.6% and 87.7%, respectively. CONCLUSION: Brachytherapy combined with EBRT and ADT can effectively control PSA level and delay biochemical relapse in localized high-risk prostate cancer. However, patients presenting with a Gleason pattern 5 should be managed with further treatment intensification.