An eight-year experience of HDR brachytherapy boost for localized prostate cancer: biopsy and PSA outcome.

PURPOSE To evaluate the biochemical recurrence-free survival (bRFS), the 2-year biopsy outcome and the prostate-specific antigen (PSA) bounce in patients with localized prostate cancer treated with an inversely planned high-dose-rate (HDR) brachytherapy boost. MATERIALS AND METHODS Data were collected from 153 patients treated between 1999 and 2006 with external beam pelvic radiation followed by an HDR Ir-192 prostate boost. These patients were given a boost of 18 to 20 Gy using inverse-planning with simulated annealing (IPSA).We reviewed and analyzed all prostate-specific antigen levels and control biopsies. RESULTS The median follow-up was 44 months (18-95 months). When categorized by risk of progression, 74.5% of patients presented an intermediate risk and 14.4% a high one. Prostate biopsies at 2 years posttreatment were negative in 86 of 94 patients (91.5%), whereas two biopsies were inconclusive. Biochemical control at 60 months was at 96% according to the American Society for Therapeutic Radiology and Oncology and the Phoenix consensus definitions. A PSA bounce (PSA values of 2 ng/mL or more above nadir) was observed in 15 patients of 123 (9.8%). The median time to bounce was 15.2 months (interquartile range, 11.0-17.7) and the median bounce duration 18.7 months (interquartile range, 12.1-29). The estimate of overall survival at 60 months was 97.1% (95% CI, 91.6-103%). CONCLUSIONS Considering that inverse planned HDR brachytherapy prostate boosts led to an excellent biochemical response, with a 2-year negative biopsy rate, we recommend a conservative approach in face of a PSA bounce even though it was observed in 10% of patients.

[1]  D. Kuban,et al.  Biochemical and clinical significance of the posttreatment prostate‐specific antigen bounce for prostate cancer patients treated with external beam radiation therapy alone , 2006, Cancer.

[2]  T. Mate,et al.  High Dose-Rate Afterloading 192Iridium Prostate Brachytherapy: Feasibility Report , 1999 .

[3]  C C Ling,et al.  High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. , 2001, The Journal of urology.

[4]  G. Gustafson,et al.  Conformal prostate brachytherapy: initial experience of a phase I/II dose-escalating trial. , 1995, International journal of radiation oncology, biology, physics.

[5]  C. Ling,et al.  Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. , 1999, International journal of radiation oncology, biology, physics.

[6]  D. Demanes,et al.  High dose rate prostate brachytherapy: the California Endocurietherapy (CET) method. , 2000, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[7]  K. Wallner,et al.  Clinical correlates to PSA spikes and positive repeat biopsies after prostate brachytherapy. , 2003, Urology.

[8]  T. Mate,et al.  Long-term outcome by risk factors using conformal high-dose-rate brachytherapy (HDR-BT) boost with or without neoadjuvant androgen suppression for localized prostate cancer. , 2004, International journal of radiation oncology, biology, physics.

[9]  G. Gustafson,et al.  Pathologic evidence of dose-response and dose-volume relationships for prostate cancer treated with combined external beam radiotherapy and high-dose-rate brachytherapy. , 2002, International journal of radiation oncology, biology, physics.

[10]  J. Cosset,et al.  [PSA bounce after permanent implant prostate brachytherapy may mimic a biochemical failure]. , 2007, Cancer Radiothérapie.

[11]  J Pouliot,et al.  Inverse planning anatomy-based dose optimization for HDR-brachytherapy of the prostate using fast simulated annealing algorithm and dedicated objective function. , 2001, Medical physics.

[12]  D. Brenner,et al.  Direct evidence that prostate tumors show high sensitivity to fractionation (low α/β ratio), similar to late-responding normal tissue , 2002 .

[13]  Jean Pouliot,et al.  Anatomy-based inverse planning dose optimization in HDR prostate implant: a toxicity study. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[14]  Chris Mitchell,et al.  Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer. , 2002, International Journal of Radiation Oncology, Biology, Physics.

[15]  J. Cosset,et al.  PSA bounce after permanent implant prostate brachytherapy may mimic a biochemical failure: a study of 295 patients with a minimum 3-year followup. , 2006, Brachytherapy.

[16]  G. Perry,et al.  Routine prostate biopsies following radiotherapy for prostate cancer: results for 226 patients. , 1995, Urology.

[17]  G. Perry,et al.  Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients. , 2000, International journal of radiation oncology, biology, physics.

[18]  F. Greene,et al.  AJCC cancer staging handbook : from the AJCC cancer staging manual , 2002 .

[19]  Ten-year results of dose escalation with 3-dimensional conformal radiotherapy for patients with clinically localized prostate cancer , 2003 .

[20]  J. Ciezki,et al.  PSA bounce predicts early success in patients with permanent iodine-125 prostate implant. , 2004, Urology.

[21]  P. Carroll,et al.  Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. , 1994, International journal of radiation oncology, biology, physics.

[22]  D J Brenner,et al.  Fractionation and protraction for radiotherapy of prostate carcinoma. , 1999, International journal of radiation oncology, biology, physics.

[23]  Alexandra L Hanlon,et al.  Prostate cancer radiotherapy dose response: an update of the fox chase experience. , 2004, The Journal of urology.

[24]  K. Wallner,et al.  Prostate-specific antigen (PSA) velocity and benign prostate hypertrophy predict for PSA spikes following prostate brachytherapy. , 2003, Brachytherapy.

[25]  Jacques Bernier,et al.  Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial , 2002, The Lancet.

[26]  H. Schmoll,et al.  F.L. Greene, D.L. Page, I.D. Fleming et al. (eds). AJCC Cancer Staging Manual, 6th edition , 2003 .

[27]  Paul Schellhammer,et al.  Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. , 2006, International journal of radiation oncology, biology, physics.

[28]  T. Pickles Prostate-specific antigen (PSA) bounce and other fluctuations: which biochemical relapse definition is least prone to PSA false calls? An analysis of 2030 men treated for prostate cancer with external beam or brachytherapy with or without adjuvant androgen deprivation therapy. , 2006, International journal of radiation oncology, biology, physics.

[29]  M W Kattan,et al.  Evaluation of a Nomogram used to predict the pathologic stage of clinically localized prostate carcinoma , 1997, Cancer.

[30]  Jean Pouliot,et al.  Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-year Canadian experience. , 2007, International journal of radiation oncology, biology, physics.

[31]  J. Fowler,et al.  Yes, the alpha/beta ratio for prostate cancer is low or "methinks the lady doth protest too much...about a low alpha/beta that is". , 2002, International journal of radiation oncology, biology, physics.

[32]  Alexandra L Hanlon,et al.  Dose response in prostate cancer with 8-12 years' follow-up. , 2001, International journal of radiation oncology, biology, physics.

[33]  D. Kuban,et al.  Prostate specific antigen bounce phenomenon after external beam radiation for clinically localized prostate cancer. , 2002, The Journal of urology.

[34]  J. Rosenwald,et al.  Influence sur les résultats des rebonds du PSA après curiethérapie de prostate : étude de 295 cas avec trois ans de suivi , 2007 .

[35]  J. Fowler,et al.  Yes, the α/β ratio for prostate cancer is low or “methinks the lady doth protest too much … about a low α/β that is” , 2002 .

[36]  S. Loening,et al.  High-dose rate interstitial with external beam irradiation for localized prostate cancer--results of a prospective trial. , 1998, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[37]  J. Pouliot,et al.  Early clinical experience with anatomy-based inverse planning dose optimization for high-dose-rate boost of the prostate. , 2002, International journal of radiation oncology, biology, physics.

[38]  I. Hsu,et al.  Normal tissue dosimetric comparison between HDR prostate implant boost and conformal external beam radiotherapy boost: potential for dose escalation. , 2000, International journal of radiation oncology, biology, physics.