Excellent long-term control with radioactive seeds in young patients with early prostate carcinoma
MO-0299
Abstract
Excellent long-term control with radioactive seeds in young patients with early prostate carcinoma
Authors: Jose Luis Guinot1, Victor Gonzalez-Perez2, Miguel A Santos1, Maria I Tortajada1, Carmen Guardino2, Juan Casanova3, Monica Nuñez1, Sandra Canos4, Veronica Cotanda2, Mar Vercher4, Mario A Vico2, Leoncio Arribas4
1Foundation Instituto Valenciano de Oncologia (IVO), Radiation Oncology, Valencia, Spain; 2Foundation Instituto Valenciano de Oncologia (IVO), Radiation Physics, Valencia, Spain; 3Foundation Instituto Valenciano de Oncologia (IVO), Urology, Valencia, Spain; 4Foundation Instituto Valenciano de Oncologia (IVO), Radiation oncology, Valencia, Spain
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Purpose or Objective
There is a tendency to propose radical prostatectomy to young men with early prostate cancer due to long life expectancy. But surgery has side effects that can alter the quality of life. We have analyzed the long-term efficacy of permanent brachytherapy (BT) with real-time system and custom-linked 125-I seeds (QuickLink™, Bard Medical) in young men up to 60 years old.
Material and Methods
Between December 2007 and May 2016 we have treated 154 men between 44 and 60 years old (median 57), 107 low risk, 26 intermediate favorable and 21 intermediate unfavorable. Median PSA was 6.37ng/ml (3.3-17.9). The clinical classification was: 113 T1c, 29 T2a, 5 T2b and 7 T2c; Gleason 3+3 in 137, Gleason 3+4 in 14, and Gleason 4+3 in 3; 15 patients had >50% positive biopsy cores. The treatment was exclusive seeds 145 Gy in 129 cases and combined external radiation 46Gy + BT 108Gy in 25 cases (51% of intermediate risk cases with combined treatment). Androgen deprivation therapy (ADT) was used in 11 cases (6 intermediate risk cases x 6 months, and 5 low risk cases x 3 months to reduce volume). The PSA control probability was calculated by the Kaplan-Meyer method.
Results
With a median follow-up of 96 months (24-159), only 3 biochemical relapses of PSA have appeared, two in low-risk cases and one in unfavorable intermediate. Ten-year biochemical relapse-free survival (BRFS) is 97.6% (at low risk 98.1%, at intermediate risk 95.8%, 100% favorable, 92.9% unfavorable). The differences are not significant by T (T1 99.1%, T2 93.7%) or by PSA level (98.5% < 10ng/ml, 97.3% >10) or by Gleason (G6 98.5%, G7 90.9%). Late complications appeared in 15%, urological in 13.6%, rectal in 1.9%, G2 4.5%, G3 4.5%. Temporary bladder catheterization was necessary in 7%, transurethral resection in 4.5%. Good or acceptable sexual function was preserved in most cases.
Conclusion
Real-time BT with custom-linked 125-I seeds offers excellent long-term BRFS results in men up to 60 years old. The rate of complications is low, and ADT was used in very few cases, since the preservation of sexual function is an important factor for young people. Therefore, brachytherapy with radioactive seeds should be considered as the first therapeutic option.