1202 FACTORS AFFECTING 15-YEAR SURVIVAL FOLLOWING PROSTATE BRACHYTHERAPY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20131202 FACTORS AFFECTING 15-YEAR SURVIVAL FOLLOWING PROSTATE BRACHYTHERAPY Nelson Stone and Richard Stock Nelson StoneNelson Stone New York, NY More articles by this author and Richard StockRichard Stock New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2556AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We analyzed the factors affecting 15-year cause specific and all cause survival in a cohort of men treated by prostate brachytherapy (PB). METHODS 1661 men with T1-T3 prostate cancer with a median age of 66 years (range 39-85) were treated with PB and followed a mean of 10 years (range 5-19). Patients were stratified into 3 risk groups based on NCCN criteria and were treated with implant alone (NCCN 1), implant plus either hormone therapy (HT) or external beam irradiation (EBRT) (NCCN 2) or implant plus HT plus EBRT (NCCN 3). HT was administered to 898 (54%) for a median of 6 months (range 1-34). Post-implant radiation dose was calculated using the biological effective dose (BED). Estimates for cause specific (CSS) and all cause survival (ACS) were determined by Kaplan Meier method with comparisons by logistic regression and Cox proportions hazard rates. RESULTS The 10 and 15-year survival rates were 98.1% and 94.1% (CSS) and 86.8% and 57% (ACS). 10 and 15-year CSS by NCCN risk groups were 99.8% and 96.3% (1); 97.7% and 97.5% (2), and 92.5% and 85.2% (3). Gleason score (GS), PSA and clinical stage (CS) were significant predictors of CSS on univariate analysis (p<0.001), while HT and BED were not. Cox regression revealed GS (p<0.001) and CS (p=0.002) as significant. At the time of this analysis 37 (2.2%) men had died of prostate cancer. Significant variables affecting ACS included HT (p=0.009), diabetes (0.016), atrial fibrillation (0.008) and heart disease (p=0.03). A history of smoking, CAD, alcohol use, asthma, other cancer, HBP, stokes and emphysema did not influence ACS. Cox regression revealed HT (p=0.007, HR 1.43), diabetes (p=0.021, HR 1.74), atrial fib (p=0.027, HR 3.09) and heart disease (p=0.053, HR 1.94) as significant. HT decreased ACS at 15 years from 60.3% to 54.9% (p=0.009). There was no decrease in ACS in patients given HT for < 6 months (p=0.140) vs. > 6 months (p=0.005). This difference persisted in younger (age < 66, p=0.017) and older men (p=0.05). 236 (14.2%) men had died at the time of this analysis. CONCLUSIONS PB yields favorable 15-year CSS, especially in high risk patients. ACS is less in patients with preexisting diabetes, atrial fibrillation and heart disease. The use of HT for longer than 6 months has a negative effect on ACS even in younger patients without an apparent beneficial effect on CSS. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e492-e493 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nelson Stone New York, NY More articles by this author Richard Stock New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...