Richard Whittington, MD
Last Modified: November 1, 2001
Dear OncoLink "Ask the Experts,"
My father was just diagnosed with prostate cancer and the impression is it's still in the early stage but aggressive. Radical prostatectomy is not recommended due to his past medical history. My father is 57 years old and re-occurrence rate is of major concern. His PSA level was 4, but the Gleason score was 7. I would like to know what are the survival and re-occurrence rates of external beam radiation and external beam radiation used together with radioactive seeds.
Thank you for your time and consideration.
Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:
First off, this would not be considered an extremely aggressive tumor with a Gleason Score 7 and a PSA of 4.0. However, it can have about a 50% mortality rate at 10 years. The experience with external radiation +/- seeds is very operator dependant. With a dose of 66 to 70 Gy (6600-7000 rads), the overall 15-year survival rate (free of tumor) is about 60%; with doses of 74 to 78 Gy, the rate may rise to 75 to 80%.
External radiation with seeds is associated with a 60% 5-year disease free survival. Some others have even reported that it may be as high as 90% at 5 years in very select patients. There is a trial that shows that the addition of hormones to external radiation, for 6 to 12 months, will increase the standard cure rates by up to 20%. Our experience with adding hormones to seeds is that is that it also raises the 5 yr disease free survival into the upper 80% range. The key is to go to a center that sees a substantial number of men with prostate cancer each year, as experience is very helpful.