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1747 BRACHYTHERAPY FOR LOCALIZED PROSTATE CANCER: OUTCOME RESULTS WITH 10 YEARS MINIMUM FOLLOW-UP
Vol. 183, No. 4, Supplement, Tuesday, June 1, 2010
METHODS: CT datasets from patients with organ confined, low and intermediate risk prostate cancer were used to develop IMRT treatment plans on both the CyberKnife VSI System and the Varian Rapid Arc System. The target as well as critical structures were identically contoured for both systems, and clinical margin expansions were made in line with current clinical practice for each IMRT device. Overall planning target volume (PTV) and doses to the rectum and bladder were compared. RESULTS: Both Robotic IMRT and conventional IMRT were able to ensure 95% coverage of the PTV for low and intermediate risk patients. The mean PTV for the Robotic IMRT cases was 35% smaller than that of the conventional IMRT cases, owing to the smaller clinical margin expansion made possible by tracking and continual intrafraction correction for prostate motion during treatment. Analysis of dose to critical structures found that the volume of rectum receiving 90% of the prescription dose (V90) was 53% higher and the bladder V90 was 64% higher for conventional IMRT as compared to Robotic IMRT (Fig 1). CONCLUSIONS: Robotic IMRT enables clinicians to deliver treatment for low and intermediate risk prostate cancer with increased precision and accuracy as compared to conventional IMRT, resulting in smaller overall target volumes and reductions of dose to surrounding critical structures. These differences may result in reduced post treatment morbidity. Further clinical studies and follow-up will be required to assess this effect.
Source of Funding: Accuray, Inc.
1747 BRACHYTHERAPY FOR LOCALIZED PROSTATE CANCER: OUTCOME RESULTS WITH 10 YEARS MINIMUM FOLLOW-UP Douglas Swartz*, Mitchell Terk, Apoorva Vashi, Jamie Cesaretti, Rosetta Hickson, Rizwan Nurani, Jacksonville, FL INTRODUCTION AND OBJECTIVES: To examine the biochemical control rate (bNED) in men treated with clinically localized prostate cancer (PCa) with a minimum of 10 years follow-up after prostate brachytherapy (BT). METHODS: 2850 patients with clinically localized prostate cancer have undergone prostate BT at our institution since 1997. 158 patients were treated between July 1997 and August 1999. Only 18 of these patients have been lost to follow-up. This analysis reviews our initial 86 consecutive patients with low or intermediate risk disease, all with 10 years minimum follow-up. Risk stratification was assigned per the NCCN guidelines. All patients were followed prospectively in our IRB approved database and assessed for clinical and biochemical recurrence based on the Phoenix definition. Low-risk PCa patients were treated with Iodine-125 BT monotherapy. Intermediate risk PCa patients received combined modality therapy of a Pd-103 BT combined with low dose external beam radiation therapy (EBRT). 40 % of patients received short course hormonal therapy (HT) for a median of 6 months. RESULTS: With a minimum of 10 years of follow-up, overall 93% of men were free from biochemical failure. On subset analysis per NCCN guidelines, 92% of patients who were low risk, and 96% of intermediate risk were free from biochemical failure at 10 years. No failures occurred after 5.5 years. 2% of patients developed grade 3 urinary toxicities and 2% developed grade 3 rectal toxicities. No grade 4 toxicities or secondary malignancies occurred. No patients developed rectal fistulae or ulceration.
THE JOURNAL OF UROLOGY姞
e675
CONCLUSIONS: Prostate seed implant in a high volume community center resulted in very low long-term biochemical failure rates in patients with low or intermediate risk disease. Long-term GU and GI toxicity were minimal. Our experience confirms the durability of biochemical control with no failures occurring beyond 5.5 years. This data represents one of the largest published series of non-actuarial 10-year outcomes. Source of Funding: None
1748 ONCOLOGICAL AND FUNCTIONAL OUTCOME FOLLOWING TOTAL PROSTATECTOMY: HOW MANY MEN ACHIEVE THE “TRIFECTA”? Elie Antebi*, Ahmed Eldefrawy, Devendar Katkoori, Cynthia Soloway, Murugesan Manoharan, Mark Soloway, Miami, FL INTRODUCTION AND OBJECTIVES: The desirable outcome after total prostatectomy (TP) for clinically localized prostate cancer (PC) is to remain recurrence free, continent and potent, together called the “trifecta”. To the best of our knowledge there are only two published reports analyzing the trifecta. Our aim is to assess the likelihood of achieving trifecta in our patients and to analyze the factors influencing the trifecta. METHODS: 1998 men with localized PC underwent TP from 1992-2008 by a single surgeon. The exclusion criteria for this study were: preoperative hormonal or radiation therapy, preoperative incontinence or impotence, follow-up less than 12 months or insufficient data. All relevant factors affecting continence, potency or biochemical recurrence (BR) were analyzed. BR was defined as PSA ⱖ0.2 ng/ml, continence as wearing no pads and potency as having erections sufficient for intercourse upon most attempts with or without a phosphodiesterase-5 inhibitor. RESULTS: 1005 patients met the inclusion criteria. The mean age of the entire cohort was 59 years. The median follow-up was 54 months (mean 62, range 12-202). The BR, potency and continence rates were 20%, 71.5% and 94% respectively. Trifecta was achieved in 63.5% at 2 year follow-up and 60.5% at 5 years. Age at surgery, PSA, biopsy Gleason sum (GS), nerve sparing (NS), prostate specimen weight, pathological GS and pathological stage were significant factors influencing the trifecta (P⬍0.001), while clinical stage and body mass index (BMI) had no significance when using univariate analysis. On multivariate analysis age, pathologic GS, pathologic stage, specimen wt and NS were independent factors. CONCLUSIONS: Age, pathologic GS, pathologic stage, specimen wt and NS were independent predictors for achieving trifecta following TP. This information will help in counseling patients undergoing TP for localized prostate cancer.
METHODS: CT datasets from patients with organ confined, low and intermediate risk prostate cancer were used to develop IMRT treatment plans on both the CyberKnife VSI System and the Varian Rapid Arc System. The target as well as critical structures were identically contoured for both systems, and clinical margin expansions were made in line with current clinical practice for each IMRT device. Overall planning target volume (PTV) and doses to the rectum and bladder were compared. RESULTS: Both Robotic IMRT and conventional IMRT were able to ensure 95% coverage of the PTV for low and intermediate risk patients. The mean PTV for the Robotic IMRT cases was 35% smaller than that of the conventional IMRT cases, owing to the smaller clinical margin expansion made possible by tracking and continual intrafraction correction for prostate motion during treatment. Analysis of dose to critical structures found that the volume of rectum receiving 90% of the prescription dose (V90) was 53% higher and the bladder V90 was 64% higher for conventional IMRT as compared to Robotic IMRT (Fig 1). CONCLUSIONS: Robotic IMRT enables clinicians to deliver treatment for low and intermediate risk prostate cancer with increased precision and accuracy as compared to conventional IMRT, resulting in smaller overall target volumes and reductions of dose to surrounding critical structures. These differences may result in reduced post treatment morbidity. Further clinical studies and follow-up will be required to assess this effect.
Source of Funding: Accuray, Inc.
1747 BRACHYTHERAPY FOR LOCALIZED PROSTATE CANCER: OUTCOME RESULTS WITH 10 YEARS MINIMUM FOLLOW-UP Douglas Swartz*, Mitchell Terk, Apoorva Vashi, Jamie Cesaretti, Rosetta Hickson, Rizwan Nurani, Jacksonville, FL INTRODUCTION AND OBJECTIVES: To examine the biochemical control rate (bNED) in men treated with clinically localized prostate cancer (PCa) with a minimum of 10 years follow-up after prostate brachytherapy (BT). METHODS: 2850 patients with clinically localized prostate cancer have undergone prostate BT at our institution since 1997. 158 patients were treated between July 1997 and August 1999. Only 18 of these patients have been lost to follow-up. This analysis reviews our initial 86 consecutive patients with low or intermediate risk disease, all with 10 years minimum follow-up. Risk stratification was assigned per the NCCN guidelines. All patients were followed prospectively in our IRB approved database and assessed for clinical and biochemical recurrence based on the Phoenix definition. Low-risk PCa patients were treated with Iodine-125 BT monotherapy. Intermediate risk PCa patients received combined modality therapy of a Pd-103 BT combined with low dose external beam radiation therapy (EBRT). 40 % of patients received short course hormonal therapy (HT) for a median of 6 months. RESULTS: With a minimum of 10 years of follow-up, overall 93% of men were free from biochemical failure. On subset analysis per NCCN guidelines, 92% of patients who were low risk, and 96% of intermediate risk were free from biochemical failure at 10 years. No failures occurred after 5.5 years. 2% of patients developed grade 3 urinary toxicities and 2% developed grade 3 rectal toxicities. No grade 4 toxicities or secondary malignancies occurred. No patients developed rectal fistulae or ulceration.
THE JOURNAL OF UROLOGY姞
e675
CONCLUSIONS: Prostate seed implant in a high volume community center resulted in very low long-term biochemical failure rates in patients with low or intermediate risk disease. Long-term GU and GI toxicity were minimal. Our experience confirms the durability of biochemical control with no failures occurring beyond 5.5 years. This data represents one of the largest published series of non-actuarial 10-year outcomes. Source of Funding: None
1748 ONCOLOGICAL AND FUNCTIONAL OUTCOME FOLLOWING TOTAL PROSTATECTOMY: HOW MANY MEN ACHIEVE THE “TRIFECTA”? Elie Antebi*, Ahmed Eldefrawy, Devendar Katkoori, Cynthia Soloway, Murugesan Manoharan, Mark Soloway, Miami, FL INTRODUCTION AND OBJECTIVES: The desirable outcome after total prostatectomy (TP) for clinically localized prostate cancer (PC) is to remain recurrence free, continent and potent, together called the “trifecta”. To the best of our knowledge there are only two published reports analyzing the trifecta. Our aim is to assess the likelihood of achieving trifecta in our patients and to analyze the factors influencing the trifecta. METHODS: 1998 men with localized PC underwent TP from 1992-2008 by a single surgeon. The exclusion criteria for this study were: preoperative hormonal or radiation therapy, preoperative incontinence or impotence, follow-up less than 12 months or insufficient data. All relevant factors affecting continence, potency or biochemical recurrence (BR) were analyzed. BR was defined as PSA ⱖ0.2 ng/ml, continence as wearing no pads and potency as having erections sufficient for intercourse upon most attempts with or without a phosphodiesterase-5 inhibitor. RESULTS: 1005 patients met the inclusion criteria. The mean age of the entire cohort was 59 years. The median follow-up was 54 months (mean 62, range 12-202). The BR, potency and continence rates were 20%, 71.5% and 94% respectively. Trifecta was achieved in 63.5% at 2 year follow-up and 60.5% at 5 years. Age at surgery, PSA, biopsy Gleason sum (GS), nerve sparing (NS), prostate specimen weight, pathological GS and pathological stage were significant factors influencing the trifecta (P⬍0.001), while clinical stage and body mass index (BMI) had no significance when using univariate analysis. On multivariate analysis age, pathologic GS, pathologic stage, specimen wt and NS were independent factors. CONCLUSIONS: Age, pathologic GS, pathologic stage, specimen wt and NS were independent predictors for achieving trifecta following TP. This information will help in counseling patients undergoing TP for localized prostate cancer.