The Impact of Hormonal Therapy on Outcome in Moderate to High Risk Prostate Cancer Treated with Permanent Radioactive Seed Implantation

Li Liu, MD
OncoLink Assistant Editor
Last Modified: October 24, 2000

Presenter: L. N. Lee
Affiliation: Mount Sinai School of Medicine, New York, NY

Background:

Prostate radioactive seed implantation is an effective treatment option for clinically organ- confined prostate carcinoma. Hormonal therapy (HT) has been used in addition to local therapy in selected group of patients in an attempt to improve long-term outcome. In this study, the researchers evaluated the impact of HT on outcome in moderate to high risk prostate cancer treated with permanent radioactive seed implantation.

Materials and Methods:

A total of 192 patients with clinically localized prostate cancer were reviewed retrospectively.
Implants were performed with either I-125 (n=72) or Pd-103 (n=119).
HT consisted of a LHRH agonist in conjunction with an anti-androgen for 3 months prior to brachytherapy and for 2-3 months afterwards.
Moderate risk was defined as having one of the following risk factors: PSA > 10, Gleason > 6 or stage > T2a., whereas high risk was defined as having two or more of above risk factors
Median follow up was 42 months.

Results:

5-year freedom from biochemical failure (FFBF) was 72% for the entire group.
In multivariate analysis, HT was the strongest significant predictor of 5-year FFBF, 79% for HT group vs. 54% for no HT group, (p=0.0001)
Pre-treatment PSA (p=0.004) and risk group (p=0.05)were also significant predictors of outcome.

Authors' Conclusions

HT given in addition to permanent seed implantation significantly improved outcome in patients with moderate to high risk prostate cancer.
In multivariate analysis, HT was the strongest predictor of improved 5-year FFBF.

Clinical/Scientific Implications:

In selected patients with organ-confined prostate cancer, hormonal therapy in addition to seed implantation may be indicated.
A prospective randomized study is warranted.