The National Cancer Data Base Report on increased use of brachytherapy for the treatment of patients with prostate carcinoma in the U.S.
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An increase in the proportion of prostate carcinomas diagnosed at early, potentially curable stages has led to several changes in treatment of patients with this disease. Greater use of radical prostatectomy and external beam radiation has been documented, and recent data suggest that the use of radiation implant (brachytherapy) also has increased. Recent results from the National Cancer Data Base (NCDB) are available to explore this trend in greater detail. Data provided by 1758 hospital cancer registries for 435,264 patients diagnosed between 1992 and 1996 were studied. Reported use of brachytherapy was analyzed by year of diagnosis, region, patient age at diagnosis, and tumor grade. The proportion of all prostate carcinoma patients treated with brachytherapy increased from 1.4% in 1992 to 3.0% in 1995. Ninety-six percent of brachytherapy patients were American Joint Committee on Cancer Stage I or II (with tumors classified as T1 or T2). As a proportion of patients in a stage group, the use of brachytherapy was greatest in Stage I; 3.7% of patients in this stage were treated by this modality. The increase in brachytherapy also was greatest among Stage I patients, rising from 2.0% in 1992 to 5.8% in 1996. Rates of use were greatest in the northeastern and southeastern U.S. and least frequently reported by institutions in the Midwest and the South. Brachytherapy was used across a wide range of patient age groups. Analysis by grade showed that 89.8% of patients treated with brachytherapy had well-differentiated or moderately differentiated tumors. Brachytherapy represented a small component of the overall pattern of care for prostate carcinoma patients in the U.S. during the interval studied. However, the rate of use of this modality for patients with localized prostate carcinoma increased substantially over the 5-year interval. This may reflect a trend toward more conservative management of prostate carcinoma. Additional monitoring and analysis of the more recent use of brachytherapy for the treatment of prostate carcinoma patients is warranted.External beam radiotherapy
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INTRODUCTION: The unpredictability of prostate cancer has become a daily challenge for the urologist, with different strategies being required to manage these cases. In this study, we report on the perspectives for curing prostate cancer in males undergoing radical prostatectomy with Gleason score of 2-6 on prostate biopsy in relation to pre-operative PSA levels. MATERIALS AND METHODS: From 1991 - 2000, we selected 440 individuals whose pathological diagnosis revealed a Gleason score of 2-6 upon prostate biopsy and who subsequently underwent retro-pubic radical prostatectomy due to localized prostate cancer. The clinical stage identified in the group under study was T1c: 206 (46.8%); T2a: 122 (27.7%); T2b: 93 (21.1%); T2c: 17 (3.9%); T3a: 2 (0.5%). Following surgery, we constructed a biochemical recurrence-free survival curve according to pre-operative PSA levels between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL, with a median follow-up of 5 years. RESULTS: Following radical prostatectomy, the pathological stage was confirmed as pT2a: 137 (31.1%); T2b: 118 (26.8%); T2c: 85 (19.3%); T3a: 67 (15.2%); T3b: 6 (1.4%); T3c: 22 (5%). The biochemical recurrence-free survival, according to PSA values between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL, was 86.6%, 62.7%, 39.8% and 24.8% respectively. CONCLUSION: Better chances for curing low-grade prostate cancer occur in individuals with normal PSA for whom a biopsy is not usually recommended.
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Men with low-risk localized prostate cancer are presented with several definitive treatment choices: radical prostatectomy, external-beam radiotherapy or brachytherapy. Although these three treatment choices confer a statistically equivalent likelihood of long- term disease-free survival, these therapies differ in their acute and long-term side-effect profiles. Brachytherapy is a minimally invasive radiotherapy procedure, and is an excellent treatment in men who do not want, or are unable to tolerate, a prostatectomy. The following article will present an overview of the epidemiology of prostate cancer, brachytherapy eligibility and a description of the techniques, side effects and efficacy, with a special emphasis on applicability to older men.
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Abstract Objective Brachytherapy is minimally invasive with few complications, so may be a good alternative to surgery for patients with prostate cancer. This study aimed to compare the therapeutic effects of brachytherapy and radical prostatectomy in the treatment of localized prostate cancer at different stages. Methods A total of 16532 patients pathologically diagnosed with prostate cancer who underwent radical prostatectomy and 16627 patients who underwent brachytherapy between 2010 and 2012 were collected through the Surveillance, Epidemiology, and End Results (SEER) Stat software. These patients were randomly matched based on age and prostate specific antigen (PSA) level at first diagnosis, and were divided into five subgroups, including G2T1c, G3T1c, G2T2a, G3T2a and G3T3b. Differences in survival were analyzed by Kaplan-Meier survival curves and compared by log-rank test. Results The overall survival (OS) and prostate cancer-specific death time (PCSDT) in the radical prostatectomy group at G3T1c stage were significantly longer than in the brachytherapy group (P<0.05), and OS, but not PCSDT, was longer than the brachytherapy group at G2T2a stage (P=0.02). But at the G2T1c, G3T2a and G3T3b stages OS and PCSDT were not significantly different between the two treatments (P>0.05). Conclusion The radical prostatectomy prognosis was superior to brachytherapy in the treatment of early-stage low-risk localized prostate cancer, whereas there was no significant difference in the prognosis of patients with moderate or high-risk localized prostate cancer.
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Abstract To compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with 125 I brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan–Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making. Study identifier at ClinicalTrials.gov : NCT01492751.
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