The Impact of Hormonal Therapy on Outcome in Moderate to High Risk Prostate Cancer Treated with Permanent Radioactive Seed Implantation
Presenter: L. N. Lee
Affiliation: Mount Sinai School of Medicine, New York, NY
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.
- 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.
- 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.
- In selected patients with organ-confined prostate cancer, hormonal therapy in addition to seed implantation may be indicated.
- A prospective randomized study is warranted.