Fifteen year follow up of the first cohort of localized prostate cancer patients treated with brachytherapy

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Abstract
4567 Background: The role of external beam radiation in addition to brachytherapy continues to be scrutinized for long term disease free survival. Methods: A cohort of 223 localized prostate cancer patients treated with iodine125 or palladium103 brachytherapy and neoadjuvant external beam radiation therapy were followed for biochemical failure, local or distant disease recurrence, and vital status. Biochemical failure (BF) was assigned if there were two consecutive PSA rises with the second greater than the first after a nadir post implant. Vital status was obtained from chart review, the social security death index, the SEER registry, and death certificate records. Time to BF was calculated and compared using Kaplan-Meier plots. Risk categories were derived from multivariate modeling and are defined as low = PSA ≤10 ng/mL, Gleason score (GS) <7, and stage 10 ng/mL or GS ≥7 or stage ≥T2c; and high = 2 or more intermediate risk factors. Results: Implants were conducted from 1987 to 1994 with average patient age at implant equal to 69 years. Median follow up time was 10 years (range 1.4 to 16.3). Twenty seven percent were low risk (n=61), 41% were intermediate (n=91) and 32% were high risk (n=71). The disease specific death rate from prostate cancer was 14% (29/212) for the sub group with known cause of death. Cause of death was unknown for 11 of 115 decedents. Fifteen year biochemical relapse free survival by risk category was the following: low = 86%, intermediate = 72% and high = 47% (log rank test score = 30.76, p=.000). Fifteen year survival was 93% for low risk, 86% for intermediate risk and 59% for high risk (log rank test score = 31.64, p = .000). Conclusions: Excellent long term biochemical and disease specific survival outcomes are achievable with prostate brachytherapy in low and intermediate risk groups. High risk patients could possibly benefit from additional adjuvant therapy.

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