Pathologic Evidence of Dose-Response and Dose-Volume Relationships for Prostate Cancer Treated with Combined External Beam Radiotherapy and High-Dose-Rate Brachytherapy

Reviewer: William Levin, MD
Last Modified: October 8, 2002

Presenter: L. Kestin
Presenter's Affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA
Type of Session: Scientific


  • There has been a long-running debate as to if prostate biopsies should be obtained following radiation therapy.
  • In this study, investigators performed a detailed pathologic review of post-irradiation prostate biopsies. They then attempted to correlate these findings with radiation dose and clinical outcome.

Materials and Methods

  • 78 patients with locally advanced prostate cancer were prospectively treated with external beam radiation therapy (EBRT) in combination with high dose rate brachytherapy (HDRB) and had post-radiation biopsies available for review.
  • EBRT (46 Gy) was followed by either 2 or 3 iridium-192 HDR implants.
  • HDRB dose was escalated from 5.50 to 10.50 Gy per implant.
  • Post-irradiation biopsies were obtained at a median interval of 1.5 years after completion of treatment.
  • All pre- and post-irradiation biopsies were reviewed by a single pathologist.
  • Median follow-up was 5.7 years.
  • The ASTRO definition for PSA failure was used.


  • 40 patients(51%) had residual tumor in post-radiation biopsies.
  • 7-year biochemical control(BC) was 79% for patients with negative biopsies, versus 33% for positive biopsies.
  • By regression analysis, biochemical failure was associated with a higher percentage of positive pre-irradiation biopsies, lower radiation dose, lower dose per implant, and a higher percentage of positive post-irradiation biopsies.
  • For patients with less than 25% pre-RT biopsies, positive 7-y BC was 81%, versus 32% for those with 50% or more positive biopsies (p=0.01)
  • Only pre-treatment cancer volume and lower RT dose were significantly associated with residual cancer.
  • For patients who received less than 80 Gy, 73% had positive post-RT biopsies, versus a 56% positve biopsy rate for 84-90 Gy, and only 39% for those who received 92 Gy or greater.

Author's Conclusions

  • Patients with positive-post RT biopsies are more likely to experience biochemical failure.
  • Patients with greater tumor volume, or those who receive a lower RT dose are more likely to have positive post-treatment biopsies and to experience biochemical failure.

Clinical/Scientific Implications

  • This study shows a correlation between a pathologic finding and the clinical course of disease.
  • It also shows that patients with a high volume of disease are at high risk for biochemical failure, even with high total radiation doses. Thus, other treatment stratagies should be investigated for these patients.
  • One issue that was not addressed by this study is the optimal timing for post-irradiation biopsy.

Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Ortho Biotech.