Brachytherapy achieves excellent results in ‘young’ prostate cancer patients
MedWire News: Men with prostate cancer who are aged 60 years or younger can achieve excellent 5- and 8-year biochemical control rates after treatment with brachytherapy, report US researchers.
Younger patients are thought to be better suited to surgical rather than radiation treatment for early prostate cancer, explain Richard Stock, from Mount Sinai School of Medicine in New York, and co-authors. This is because being of younger age is associated with a negative prognosis, they note.
Stock and colleagues found, however, that the rates of biochemical control achieved after BRT in men aged 60 years or less were comparable to those of older men, suggesting that surgery may not always need to be the first option.
The team analyzed biochemical outcomes for 1665 men with localized prostate cancer (clinical stage T1 or T2) treated with brachytherapy, 378 of whom were aged 60 years or under, and 1287 of whom were aged over 60 years.
Biochemical failure was defined as a prostate-specific antigen (PSA) measurement 2 ng/ml above the nadir.
After a median follow-up of 68 and 66 months in the younger and older group, respectively, the actuarial 5- and 8- year freedom from biochemical failure (FFbF) rates were non-significantly different, at 95% and 92% versus 93% and 87%, respectively. In all, 148 (9%) patients experienced biochemical failure at a median of 40 months after treatment.
Multivariate analysis of the entire cohort revealed that Gleason score (≤6 vs 7 vs ≥8), pre-treatment PSA (≤10 ng/ml vs 10-20 ng/ml vs ≥20 ng/ml), and total radiation dose (≤150 Gy vs >150 Gy) were significantly associated with FFbF while age was not.
Considering each age group individually, among younger men, only total radiation dose was significantly associated with FFbF, while for older men, Gleason score, PSA, and total radiation dose were all significantly associated with FFbF.
The researchers also assessed toxicity in the cohort after brachytherapy, and observed higher incidences of toxicity in the older group of men.
Overall, 34% of older versus 10% of younger men experienced a decline in erectile function, 32% versus 29% experienced any grade rectal bleeding, and 9% versus 7% experienced urinary retention, respectively, at some point during follow-up.
"Young age should not be a deterrent when considering [brachytherapy] as a primary treatment option for clinically localized prostate cancer" conclude Stock et al in the International Journal of Radiation Oncology Biology Physics.
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By Sarah Guy