HDR Brachytherapy With External Beam Radiotherapy and Androgen Deprivation Therapy for Prostate Cancer: Initial Six-Year Experience at St. George Cancer Care Centre

Abstract

Purpose: In 2003, combination treatment for locally advanced prostate cancer with external beam radiation, HDR Brachytherapy boost, and androgen deprivation therapy was initiated at St. George Hospital in Sydney. 235 patients have been treated to date. The purpose of this study is to examine the outcomes of this treatment strategy with a focus on assessment of treatment toxicity and impact on quality of life. Early disease control outcomes will also be presented.Materials and Methods: From May 2003 to May 2009, 200 patients underwent treatment with HDR Brachytherapy (19.5Gy in 3 fractions or 18Gy in 2 fractions) followed by external beam radiotherapy (46Gy in 23 fractions). Ninety percent of patients were treated with androgen deprivation therapy. Eligibility criteria include localized intermediate and high risk prostate cancer, PSA up to 40, and fitness for surgery. Disease control and toxicity data were prospectively collected at baseline and each subsequent followup including assessment of PSA, urinary, bowel, and sexual function, and quality of life. Biochemical control and survival data are also reported.Results: 200 patients, with a mean age of 65 years, were treated between May 2003 and May 2009. Of these, 50% had high risk disease. Median followup was 3 years. Early and late grade 3 urinary toxicity occurred in 8.5% and 12% respectively including a 7.5% risk of acute catheterization and a 5% risk of urethral stricture. Grade 3 rectal toxicity occurred in 4.5% with the majority of cases successfully treated with formalin or argon laser coagulation. There was no grade 4 urinary or bowel toxicity. At baseline, 45% of men had normal sexual function. Of these patients, 35% retained erectile function following treatment. Sexual function outcomes were related to duration of hormone use. 7.3% of patients have developed a biochemical recurrence and 3.3% have developed metastases. There has been one prostate cancer related death at 5.5 years post treatment.Conclusions: For the majority of men, this treatment is well tolerated and early disease control outcomes, including biochemical control, appear promising. This combination treatment is an effective method of dose escalation to improve outcomes for men with locally advanced prostate cancer, though long-term followup is required to confirm these findings. Purpose: In 2003, combination treatment for locally advanced prostate cancer with external beam radiation, HDR Brachytherapy boost, and androgen deprivation therapy was initiated at St. George Hospital in Sydney. 235 patients have been treated to date. The purpose of this study is to examine the outcomes of this treatment strategy with a focus on assessment of treatment toxicity and impact on quality of life. Early disease control outcomes will also be presented. Materials and Methods: From May 2003 to May 2009, 200 patients underwent treatment with HDR Brachytherapy (19.5Gy in 3 fractions or 18Gy in 2 fractions) followed by external beam radiotherapy (46Gy in 23 fractions). Ninety percent of patients were treated with androgen deprivation therapy. Eligibility criteria include localized intermediate and high risk prostate cancer, PSA up to 40, and fitness for surgery. Disease control and toxicity data were prospectively collected at baseline and each subsequent followup including assessment of PSA, urinary, bowel, and sexual function, and quality of life. Biochemical control and survival data are also reported. Results: 200 patients, with a mean age of 65 years, were treated between May 2003 and May 2009. Of these, 50% had high risk disease. Median followup was 3 years. Early and late grade 3 urinary toxicity occurred in 8.5% and 12% respectively including a 7.5% risk of acute catheterization and a 5% risk of urethral stricture. Grade 3 rectal toxicity occurred in 4.5% with the majority of cases successfully treated with formalin or argon laser coagulation. There was no grade 4 urinary or bowel toxicity. At baseline, 45% of men had normal sexual function. Of these patients, 35% retained erectile function following treatment. Sexual function outcomes were related to duration of hormone use. 7.3% of patients have developed a biochemical recurrence and 3.3% have developed metastases. There has been one prostate cancer related death at 5.5 years post treatment. Conclusions: For the majority of men, this treatment is well tolerated and early disease control outcomes, including biochemical control, appear promising. This combination treatment is an effective method of dose escalation to improve outcomes for men with locally advanced prostate cancer, though long-term followup is required to confirm these findings.