Brachytherapy combo improves prostate cancer results

Jul 21, 2009

Men diagnosed with high-risk prostate cancer who have brachytherapy treatment combined with external-beam radiation therapy (EBRT) and androgen suppression therapy (AST) have a lower risk of dying from the disease, compared to those who receive only brachytherapy, or brachytherapy in combination with AST or EBRT.

This finding was revealed in an outcomes study of more than 1,300 men published online in the Journal of Clinical Oncology (July 14, 2009).

If statistics since 2000 hold true for 2009, approximately 32,687 men will have a high-risk version of prostate cancer. This represents 17% of the 192,280 men in the U.S. estimated by the American Cancer Society (ACS) to be diagnosed annually with prostate cancer. An increasing number of men worldwide are choosing to undergo brachytherapy for high-risk prostate cancer, but a variety of treatment approaches are used.

The effectiveness of the most common brachytherapy treatments was analyzed by a research team led by Dr. Anthony D'Amico, Ph.D., chairman of the division of genitourinary radiation oncology at Dana-Farber Cancer Institute in Boston. The group found the triple treatment to be most effective and expressed concern that a significant number of the high-risk patients who select prostate brachytherapy may be inadvertently undertreated.

The researchers analyzed the outcomes of 1,342 men who were treated at the Chicago Prostate Cancer Center or at one of 20 21st Century Oncology community-based cancer centers located in Florida, New York, and North Carolina between August 1991 and November 2005. The median follow-up period was 5.1 years, with a range of 3.4 to 7.0 years.

Analysis of prostate cancer treatment regimens

Category	No. of patients	% of total 1991-1995	% of total 1996-2000	% of total 2001-2005	Adjusted hazard ratio
Brachytherapy only	221 (16.46%)	2.60%	5.44%	8.42%	1.0
Brachytherapy + AST	254 (18.92%)	1.19%	6.78%	10.95%	0.63
Brachytherapy + EBRT	217 (16.16%)	0.52%	5.81%	9.83%	0.57
Brachytherapy + AST + EBRT	650 (48.43%)	0.30%	21.16%	26.97%	0.32

The men who received all three treatments had a higher proportion of more clinically advanced and higher grade cancers.

Because of the increased toxicity causing worse urinary and sexual function for the triple treatment, the authors recommended that a randomized study be conducted to evaluate both cancer control and toxicity of dose-escalated EBRT and AST versus low-dose EBRT, a brachytherapy boost, and AST in men with high-risk prostate cancer.

External radiation and brachytherapy effective for high-risk prostate cancer, August 27, 2007