Brachytherapy boost and cancer-specific mortality in favorable high-risk versus other high-risk prostate cancer

Vinayak Muralidhar; Michael Xiang; Peter F. Orio III; Neil E. Martin; Clair J. Beard; Felix Y. Feng; Karen E. Hoffman; Paul L. Nguyen

doi:10.5114/jcb.2016.58080

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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1/2016
vol. 8

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abstract:

Original paper

Brachytherapy boost and cancer-specific mortality in favorable high-risk versus other high-risk prostate cancer

Vinayak Muralidhar

,

Michael Xiang

,

Peter F. Orio III

,

Neil E. Martin

,

Clair J. Beard

,

Felix Y. Feng

,

Karen E. Hoffman

,

Paul L. Nguyen

J Contemp Brachytherapy 2016; 8, 1: 1–6

DOI: https://doi.org/10.5114/jcb.2016.58080

Online publish date: 2016/02/29

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Purpose: Recent retrospective data suggest that brachytherapy (BT) boost may confer a cancer-specific survival benefit in radiation-managed high-risk prostate cancer. We sought to determine whether this survival benefit would extend to the recently defined favorable high-risk subgroup of prostate cancer patients (T1c, Gleason 4 + 4 = 8, PSA < 10 ng/ml or T1c, Gleason 6, PSA > 20 ng/ml).

Material and methods: We identified 45,078 patients in the Surveillance, Epidemiology, and End Results database with cT1c-T3aN0M0 intermediate- to high-risk prostate cancer diagnosed 2004-2011 treated with external beam radiation therapy (EBRT) only or EBRT plus BT. We used multivariable competing risks regression to determine differences in the rate of prostate cancer-specific mortality (PCSM) after EBRT + BT or EBRT alone in patients with intermediate-risk, favorable high-risk, or other high-risk disease after adjusting for demographic and clinical factors.

Results: EBRT + BT was not associated with an improvement in 5-year PCSM compared to EBRT alone among patients with favorable high-risk disease (1.6% vs. 1.8%; adjusted hazard ratio [AHR]: 0.56; 95% confidence interval [CI]: 0.21-1.52, p = 0.258), and intermediate-risk disease (0.8% vs. 1.0%, AHR: 0.83, 95% CI: 0.59-1.16, p = 0.270). Others with high-risk disease had significantly lower 5-year PCSM when treated with EBRT + BT compared with EBRT alone (3.9% vs. 5.3%; AHR: 0.73; 95% CI: 0.55-0.95; p = 0.022).

Conclusions: Brachytherapy boost is associated with a decreased rate of PCSM in some men with high-risk prostate cancer but not among patients with favorable high-risk disease. Our results suggest that the recently-defined “favorable high-risk” category may be used to personalize therapy for men with high-risk disease.

keywords:

Brachytherapy boost and cancer-specific mortality in favorable high-risk versus other high-risk prostate cancer

Vinayak Muralidhar , Michael Xiang , Peter F. Orio III , Neil E. Martin , Clair J. Beard , Felix Y. Feng , Karen E. Hoffman , Paul L. Nguyen

brachytherapy, favorable high-risk prostate cancer, high-risk prostate cancer, risk stratification

Vinayak Muralidhar

,

Michael Xiang

,

Peter F. Orio III

,

Neil E. Martin

,

Clair J. Beard

,

Felix Y. Feng

,

Karen E. Hoffman

,

Paul L. Nguyen