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Prostate Cancer Death is Unlikely in High-Risk Patients Following High-Quality Brachytherapy
S54
Abstracts / Brachytherapy 9 (2010) S23eS102
hypertension, presence of dyslipidemia, alcohol use, race, biopsy Gleason score, and clinical stage. Univariate and multivariable analyses for cause specific-survival were done using proportional hazards competing risk regression analysis. Results: Fifty-two percent of patients were treated with RP, 30% with PI, and 18% with RT. The median followup for all patients was 48 months (range: 0.1-126). More than 50% of patients were treated after 2001. At the time of analysis, 264 patients (6.3%) had died - 23 from prostate cancer, 92 from coronary artery disease, 94 from other cancers, and 55 from other causes. The results of the prostate cancer-specific mortality multivariable analysis reveal that RT was associated with worse outcome relative to PI and RP (p ! 0.001). Conclusions: Low- and intermediate-risk prostate cancer patients treated with RT had a higher risk of death due to prostate cancer than patients treated with RP or PI after adjusting for factors that influence overall and prostate cancer-specific mortality.
OR65 Presentation Time: 11:40 AM Prostate Cancer Death is Unlikely in High-Risk Patients Following High-Quality Brachytherapy Gregory S. Merrick, M.D.1, Wayne M. Butler, Ph.D.1, Robert W. Galbreath, Ph.D.1, Jonathan H. Lief, Ph.D.1, Zachariah A. Allen, M.S.1, Kent E. Wallner, M.D.2, Edward Adamovich, M.D.3 1Radiation Oncology, Schiffler Cancer Center/Wheeling Jesuit University, Wheeling, WV; 2Puget Sound Healthcare Corportation, University of Washington, Seattle, WA; 3 Pathology, Wheeling Hospital, Wheeling, WV. Purpose: The management of high-risk prostate cancer remains controversial. Despite cure rates of approximately 40% for high-risk patients in the modern radical prostatectomy era, radical prostatectomy is being increasingly utilized in this patient population. In this study, we evaluate cause-specific survival (CSS), specific causes of death, biochemical progression-free survival (bPFS) and overall survival (OS) in high risk prostate cancer patients undergoing brachytherapy with or without supplemental therapies. Materials and Methods: Between April 1995 and June 2005, 284 patients with high-risk prostate cancer (Gleason score >8 or PSA O20ng/mL or clinical stage >T2c) underwent permanent interstitial brachytherapy. 257 patients (90.5%) received supplemental XRT and 179 patients (63.0%) received androgen deprivation therapy (ADT). Mean and median followup were 7.8 and 8.0 years, respectively, with a maximum followup of 14.3 years. The median post-implant day 0 D90 was 119% of prescription dose. Cause of death was determined for each deceased patient. Patients with metastatic prostate cancer or castrate resistant disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment and dosimetric parameters were evaluated for impact on survival. Results: The 12 year CSS, bPFS and OS were 94.2%, 89.0% and 69.7%. In multivariate analysis, bPFS was best predicted by percent positive biopsies and androgen deprivation therapy. A Cox linear regression analysis failed to identify any specific predictors for CSS, while OS was best predicted by patient age, percent positive biopsies and diabetes. Overall, cause of death was determined to be a result of diseases of the heart in 14%, nonprostate cancers in 8%, other causes in 8% and prostate cancer in 6% of patients at 12 years. When overall survival was stratified by the number of co-morbidities (obesity, hypertension, diabetes, coronary artery disease, hypercholesterolemia and tobacco) patients with 0-3 comorbidities had a 12-year overall survival of 73.0% while those patients with 4 or more co-morbidities had an overall survival rate of 52.7% (p 5 0.036). Conclusions: High-quality brachytherapy results in favorable biochemical control rates and cause-specific survival for patients with high risk disease. Death from diseases of the heart is more than twice as likely as death from prostate cancer. Strategies to improve cardiovascular health in high risk prostate cancer patients may positively impact OS.
OR66
Presentation Time: 11:50 AM
Androgen Deprivation Therapy in High-Risk Prostate Cancer with Gleason Score 8-10 and PSA <15 Treated with Permanent Interstitial Brachytherapy L. Christine Fang, M.D.1, Gregory S. Merrick, M.D.2, Brian Murray, B.S.2, Kent E. Wallner, M.D.3, Wayne M. Butler, Ph.D.2, Robert W. Galbreath, Ph.D.2 1Radiation Oncology, University of Washington, Seattle, WA; 2 Radiation Oncology, Schiffler Cancer Center/Wheeling Jesuit University, Wheeling, WV; 3Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA. Purpose: With the use of PSA screening, there has been an increase in men diagnosed with high-risk prostate cancer defined by Gleason score 8-10 but coupled with relatively low PSA. This is a unique group of patients that has been less than completely investigated and thus optimal management has yet to be clearly defined; this includes the decision regarding the use androgen deprivation therapy (ADT). This retrospective study was performed to analyze biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) in Gleason score 8-10 patients with a pre-treatment PSA <15ng/mL treated with an approach that included permanent interstitial brachytherapy with or without ADT. Materials and Methods: Eligibility criteria for this study were the following: 1) histologic diagnosis of adenocarcinoma of the prostate, 2) Gleason score 8-10, 3) PSA <15 ng/mL at the time of diagnosis, 4) no evidence of distant metastases. The median day 0 D90 was 121.1% of prescription dose. All patients were treated with permanent prostate brachytherapy with and without supplemental external beam radiation therapy (EBRT) and/or androgen deprivation therapy (ADT). KaplanMeier analyses were performed for bPFS, CSS and OS. bPFS was defined by a PSA <0.40ng/mL after nadir. Patients with metastatic prostate cancer or castrate resistant disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment and dosimetric parameters were evaluated for impact on survival. Results: Between April 1995 and October 2005, 174 patients met eligibility criteria and are included in this analysis. The median followup was 6.6 years (range 3-14 years). 103Pd was utilized in 173 of the cases and 125I in 1 case. One hundred fifty-nine (91%) patients received supplemental EBRT and 113 (65%) patients received ADT. Median PSA was 7.1 ng/mL, median Gleason score was 8 (range 8-10) and median age was 68. Eleven-year OS, CSS and bPFS were 62%, 94% and 90%, respectively. The estimated 11-year outcomes for men treated with ADT versus without ADT were 93% and 86% for bPFS (p50.204), 93% and 95% (p50.562) for CSS and 50% and 71% for OS (p50.179), respectively. On multivariate analysis, age (RR 1.1; p-value50.03) and stage (RR 2.6; p-value50.007) were significant predictors of OS. PSA, Gleason score, ADT use and duration of ADT were not statistically significant prognosticators for bPFS or CSS. Conclusions: Patients with Gleason scores 8-10 and PSA <15ng/mL have excellent biochemical outcomes and cause-specific survival following a brachytherapy approach. The use of ADT did not substantially impact CSS or bPFS. However, there is suggestion of OS detriment with the use of ADT in this group of patients.
OR67
Presentation Time: 12:00 PM
Relationship between Prebrachytherapy Erectile Function, Age and Overall Survival Gregory S. Merrick, M.D.1, Wayne M. Butler, Ph.D.1, Robert W. Galbreath, Ph.D.1, Jonathan H. Lief, Ph.D.1, Zachariah A. Allen, M.S.1, Kent E. Wallner, M.D.2 1Radiation Oncology, Schiffler Cancer Center/ Wheeling Jesuit University, Wheeling, WV; 2Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA. Purpose: It has been reported that erectile dysfunction in younger men is associated with a marked increase in the risk of future cardiac events, whereas in older men erectile dysfunction may be of lesser prognostic cardiac importance. In this study, we evaluated whether pre-implant
Abstracts / Brachytherapy 9 (2010) S23eS102
hypertension, presence of dyslipidemia, alcohol use, race, biopsy Gleason score, and clinical stage. Univariate and multivariable analyses for cause specific-survival were done using proportional hazards competing risk regression analysis. Results: Fifty-two percent of patients were treated with RP, 30% with PI, and 18% with RT. The median followup for all patients was 48 months (range: 0.1-126). More than 50% of patients were treated after 2001. At the time of analysis, 264 patients (6.3%) had died - 23 from prostate cancer, 92 from coronary artery disease, 94 from other cancers, and 55 from other causes. The results of the prostate cancer-specific mortality multivariable analysis reveal that RT was associated with worse outcome relative to PI and RP (p ! 0.001). Conclusions: Low- and intermediate-risk prostate cancer patients treated with RT had a higher risk of death due to prostate cancer than patients treated with RP or PI after adjusting for factors that influence overall and prostate cancer-specific mortality.
OR65 Presentation Time: 11:40 AM Prostate Cancer Death is Unlikely in High-Risk Patients Following High-Quality Brachytherapy Gregory S. Merrick, M.D.1, Wayne M. Butler, Ph.D.1, Robert W. Galbreath, Ph.D.1, Jonathan H. Lief, Ph.D.1, Zachariah A. Allen, M.S.1, Kent E. Wallner, M.D.2, Edward Adamovich, M.D.3 1Radiation Oncology, Schiffler Cancer Center/Wheeling Jesuit University, Wheeling, WV; 2Puget Sound Healthcare Corportation, University of Washington, Seattle, WA; 3 Pathology, Wheeling Hospital, Wheeling, WV. Purpose: The management of high-risk prostate cancer remains controversial. Despite cure rates of approximately 40% for high-risk patients in the modern radical prostatectomy era, radical prostatectomy is being increasingly utilized in this patient population. In this study, we evaluate cause-specific survival (CSS), specific causes of death, biochemical progression-free survival (bPFS) and overall survival (OS) in high risk prostate cancer patients undergoing brachytherapy with or without supplemental therapies. Materials and Methods: Between April 1995 and June 2005, 284 patients with high-risk prostate cancer (Gleason score >8 or PSA O20ng/mL or clinical stage >T2c) underwent permanent interstitial brachytherapy. 257 patients (90.5%) received supplemental XRT and 179 patients (63.0%) received androgen deprivation therapy (ADT). Mean and median followup were 7.8 and 8.0 years, respectively, with a maximum followup of 14.3 years. The median post-implant day 0 D90 was 119% of prescription dose. Cause of death was determined for each deceased patient. Patients with metastatic prostate cancer or castrate resistant disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment and dosimetric parameters were evaluated for impact on survival. Results: The 12 year CSS, bPFS and OS were 94.2%, 89.0% and 69.7%. In multivariate analysis, bPFS was best predicted by percent positive biopsies and androgen deprivation therapy. A Cox linear regression analysis failed to identify any specific predictors for CSS, while OS was best predicted by patient age, percent positive biopsies and diabetes. Overall, cause of death was determined to be a result of diseases of the heart in 14%, nonprostate cancers in 8%, other causes in 8% and prostate cancer in 6% of patients at 12 years. When overall survival was stratified by the number of co-morbidities (obesity, hypertension, diabetes, coronary artery disease, hypercholesterolemia and tobacco) patients with 0-3 comorbidities had a 12-year overall survival of 73.0% while those patients with 4 or more co-morbidities had an overall survival rate of 52.7% (p 5 0.036). Conclusions: High-quality brachytherapy results in favorable biochemical control rates and cause-specific survival for patients with high risk disease. Death from diseases of the heart is more than twice as likely as death from prostate cancer. Strategies to improve cardiovascular health in high risk prostate cancer patients may positively impact OS.
OR66
Presentation Time: 11:50 AM
Androgen Deprivation Therapy in High-Risk Prostate Cancer with Gleason Score 8-10 and PSA <15 Treated with Permanent Interstitial Brachytherapy L. Christine Fang, M.D.1, Gregory S. Merrick, M.D.2, Brian Murray, B.S.2, Kent E. Wallner, M.D.3, Wayne M. Butler, Ph.D.2, Robert W. Galbreath, Ph.D.2 1Radiation Oncology, University of Washington, Seattle, WA; 2 Radiation Oncology, Schiffler Cancer Center/Wheeling Jesuit University, Wheeling, WV; 3Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA. Purpose: With the use of PSA screening, there has been an increase in men diagnosed with high-risk prostate cancer defined by Gleason score 8-10 but coupled with relatively low PSA. This is a unique group of patients that has been less than completely investigated and thus optimal management has yet to be clearly defined; this includes the decision regarding the use androgen deprivation therapy (ADT). This retrospective study was performed to analyze biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) in Gleason score 8-10 patients with a pre-treatment PSA <15ng/mL treated with an approach that included permanent interstitial brachytherapy with or without ADT. Materials and Methods: Eligibility criteria for this study were the following: 1) histologic diagnosis of adenocarcinoma of the prostate, 2) Gleason score 8-10, 3) PSA <15 ng/mL at the time of diagnosis, 4) no evidence of distant metastases. The median day 0 D90 was 121.1% of prescription dose. All patients were treated with permanent prostate brachytherapy with and without supplemental external beam radiation therapy (EBRT) and/or androgen deprivation therapy (ADT). KaplanMeier analyses were performed for bPFS, CSS and OS. bPFS was defined by a PSA <0.40ng/mL after nadir. Patients with metastatic prostate cancer or castrate resistant disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment and dosimetric parameters were evaluated for impact on survival. Results: Between April 1995 and October 2005, 174 patients met eligibility criteria and are included in this analysis. The median followup was 6.6 years (range 3-14 years). 103Pd was utilized in 173 of the cases and 125I in 1 case. One hundred fifty-nine (91%) patients received supplemental EBRT and 113 (65%) patients received ADT. Median PSA was 7.1 ng/mL, median Gleason score was 8 (range 8-10) and median age was 68. Eleven-year OS, CSS and bPFS were 62%, 94% and 90%, respectively. The estimated 11-year outcomes for men treated with ADT versus without ADT were 93% and 86% for bPFS (p50.204), 93% and 95% (p50.562) for CSS and 50% and 71% for OS (p50.179), respectively. On multivariate analysis, age (RR 1.1; p-value50.03) and stage (RR 2.6; p-value50.007) were significant predictors of OS. PSA, Gleason score, ADT use and duration of ADT were not statistically significant prognosticators for bPFS or CSS. Conclusions: Patients with Gleason scores 8-10 and PSA <15ng/mL have excellent biochemical outcomes and cause-specific survival following a brachytherapy approach. The use of ADT did not substantially impact CSS or bPFS. However, there is suggestion of OS detriment with the use of ADT in this group of patients.
OR67
Presentation Time: 12:00 PM
Relationship between Prebrachytherapy Erectile Function, Age and Overall Survival Gregory S. Merrick, M.D.1, Wayne M. Butler, Ph.D.1, Robert W. Galbreath, Ph.D.1, Jonathan H. Lief, Ph.D.1, Zachariah A. Allen, M.S.1, Kent E. Wallner, M.D.2 1Radiation Oncology, Schiffler Cancer Center/ Wheeling Jesuit University, Wheeling, WV; 2Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA. Purpose: It has been reported that erectile dysfunction in younger men is associated with a marked increase in the risk of future cardiac events, whereas in older men erectile dysfunction may be of lesser prognostic cardiac importance. In this study, we evaluated whether pre-implant