Combined brachytherapy and external beam radiation for prostate cancer in a community setting

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16147-e16147
Author(s):  
G. J. Kubicek ◽  
G. J. Kubicek ◽  
S. Brown ◽  
S. Redfield
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Treatment Options ◽  
Community Setting ◽  
Late Toxicity ◽  
Biochemical Failure ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

e16147 Background: Prostate cancer is the most common male malignancy, and there is no one standard treatment modality. One treatment option is the combination of external beam radiotherapy and permanent transperineal brachytherapy seed implant Methods: Retrospective review of prostate cancer and side effect outcomes at a single institution in the community setting. All patients were treated with a combination of low dose rate transperineal brachytherapy seed placement and external beam radiation. Results: A total of 897 patients were analyzed, 781 had a minimum follow-up of one year. Median pre-treatment PSA was 8.1 (range 0.3 to 106) and the median Gleason score was 6. With a median follow-up of 3.6 years, 33 (3.4 %) patients had biochemical failure based on the phoenix definition of Nadir + 2. Not including impotence, acute toxicity greater than or equal to Grade 2 was seen in 115 patients (102 GU and 13 GI) and 193 patients had late toxicity greater than or equal to Grade 2 (155 GU and 38 GI). 563 patients received hormone therapy prior to or concurrent with the radiation. Conclusions: This is the largest series reporting on the outcome of combination brachytherpay implant and external beam radiation in the treatment of prostate cancer. Combination treatment using brachytherapy and external beam radiation is well tolerated, with a low rate of biochemical failure and should be considered one of the treatment options for prostate cancer. No significant financial relationships to disclose.

scholarly journals Assessing the Optimum Use of Androgen-Deprivation Therapy in High-Risk Prostate Cancer Patients Undergoing External Beam Radiation Therapy

2016 ◽  
Vol 11 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Michelle S. Ludwig ◽  
Deborah A. Kuban ◽  
Sara S. Strom ◽  
Xianglin L. Du ◽  
David S. Lopez ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Distant Metastasis ◽  
External Beam Radiation Therapy ◽  
Biochemical Failure ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

The optimum use of androgen deprivation therapy (ADT) in high-risk prostate cancer patients has not been defined in the setting of dose-escalated external beam radiation therapy. A retrospective analysis of 1,290 patients with high-risk prostate cancer from June 1987 through March 2010 treated with external beam radiation therapy was performed. Median follow-up was 7.2 years, and 797 patients received ADT, with 384 patients experiencing a biochemical failure and 145 with distant metastasis. ADT was associated with lower risk of biochemical failure and distant metastasis than no ADT after adjusting for age, prostate-specific antigen (PSA), Gleason score, year of diagnosis, tumor stage, and radiation dose. ADT was associated with a greater reduction in biochemical failure in the low-dose radiation group than in the high-dose group. Patients with >24 months of ADT had a lower risk of PSA failures than those with <24 months. ADT was associated with decreased risk of biochemical failure and distant metastasis in all patients. The effect of ADT on reducing risk of biochemical failure was greater among men with low-dose radiation. There was a benefit in PSA and distant metastasis-free survival with >24 months of ADT in all patients who received ADT.

scholarly journals The Modern View on the Effectiveness of Cradiotherapy of Prostate Cancer

2017 ◽  
Vol 10 (3) ◽  
pp. 231-235
Author(s):  
Ivan Petrovich Moshurov ◽  
Dmitry Yuryevich Kamenev ◽  
Bronislava Borisovna Kravets ◽  
Natalia Viktorovna Korotkikh
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
External Beam Radiotherapy ◽  
External Beam Radiation ◽  
High Dose ◽  
External Beam ◽  
Beam Radiation ◽  
Results Of Treatment ◽  
Short Period

For many years the main method of treatment of patients with prostate cancer remains surgical treatment, which consists in performing a difficult and traumatic operations, leading to reduced quality of life. Currently, as an equal alternative to radical prostatectomy is radiotherapy, presented with a standard 3D conformal beam radiation, stereotactic radiotherapy and brachytherapy using sources with a low or high dose. Brachytherapy using sources of high power is a safe and effective treatment for localized prostate cancer, providing a summing fatal dose to the tumor with the short period of hospitalization, minimal complications, which may be used in combination with external beam radiotherapy and standalone version. A brief review of the literature on the use of combined radiation therapy in the treatment of prostate cancer. Describes the comparative characteristics of results of treatment of this pathology, complications, early and late toxic reactions when used brachytherapy isotopes of different dose in combination with external beam radiation therapy. The vector of further research in this direction is justified.

Variations in treatment modality use for the definitive management of prostate cancer in the United States.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 174-174
Author(s):  
Jay P. Ciezki ◽  
Chandana A. Reddy ◽  
James Ulchaker ◽  
Kenneth Angermeier ◽  
Kevin L. Stephans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Treatment Modality ◽  
External Beam Radiotherapy ◽  
The United States ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Choice Of Treatment ◽  
To Receive

174 Background: No prospective, randomized comparative efficacy trial exists to guide treatment of definitively managed prostate cancer patients. Despite this, treatment selection varies nationally and we attempt to assess these patterns of use. Methods: The SEER database was queried to identify cases of prostate cancer diagnosed between 1998-2008. The modalities identified were brachytherapy (brachy), combination of brachytherapy and external beam radiation (CombRT), external beam radiotherapy (EBRT), radical prostatectomy and external beam radiotherapy (RP+RT), and radical prostatectomy (RP). The number of cases by year, patient age and SEER region was computed. Results: There were 361,135 men in this analysis: 12.4% brachy, 6.8% CombRT, 27.5% EBRT, 3.1% RP+RT, and 50.3% RP. As expected, treatment modality varied by age with younger men more likely to receive RP and older man more likely to receive EBRT or brachy. There was some variation in choice of treatment modality over time: 6.6% for brachy; 4.2% for CombRT; 1.9% for EBRT; 2.0% for RP+RT; and 7.8% for RP. The variation in treatment modality by region was surprisingly wide (table): 14.4% for brachy; 25.5% for CombRT; 28.5% for EBRT; 3.8% for RP+RT; and 26.8% for RP. Conclusions: Choice of prostate cancer treatment modality varies by age, year of treatment, and most notably geographical region. Surprisingly the changes in reimbursement rates over the study period seem to have had minimal impact on choice of treatment modality. The regional variation implies that affiliations among healthcare providers significantly impact treatment. [Table: see text]

Impact of timing of biochemical failure on the eventual development of clinical failure after definitive treatment with brachytherapy or external beam radiotherapy for prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 53-53
Author(s):  
Jay P. Ciezki ◽  
Chandana A. Reddy ◽  
Eric A. Klein ◽  
James Ulchaker ◽  
Kenneth Angermeier ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Biochemical Failure ◽  
Definitive Treatment ◽  
External Beam ◽  
Clinical Failure ◽  
Psa Testing ◽  
Testing Frequency ◽  
Definitive Therapy

53 Background: Late treatment failure is often considered to be a rare event. We will assess the influence of the timing of biochemical failure (bF) after definitive brachytherapy (BT) or external beam radiotherapy (EBRT) for prostate cancer on its frequency and association with clinical failure (cF). Methods: Patients with prostate cancer treated between 1996 and 2009 with at least 5 years of follow-up (N= 2,293; 1,060 EBRT, 1,233 BT) were studied in the context of an IRB-approved inception cohort study. Those with a bF were reviewed to determine the timing of bF [< 5 years after treatment (bF<5) vs. > 5 years after treatment (bF>5)] and occurrence of cF post-bF. The bF definition used was the nadir + 2.0 ng/mL version. Results: Of the total patient population, 477 (21%) were noted to have bF- 244 (11%) bF<5 vs. 233 (10%) bF>5. The median follow-up after bF for the bF< 5 group is 41 months while in the bF> 5 group it is 22 months. In the BT group, 94 (8%) failed < 5 years and 87 (7%) failed > 5 years. In the EBRT group, 150 (14%) failed < 5 years and 146 (14%) failed > 5 years. The median PSA value (ng/mL) at the time of bF for all patients, EBRT, and BT in the bF<5 group was 3.70, 3.65, and 3.80, respectively (p=not significant). The median PSA value (ng/mL) at the time of bF for all patients, EBRT, and BT in the bF>5 group was 3.01, 3.01, and 3.04, respectively (p=not significant). Overall, 53.3% of patients in the bF<5 group developed cF while 27% of patients in the bF>5 group developed a cF. The actuarial five year rate of cF for the bF <5 group was 50% vs. 38% for the bF>5 group (p= 0.028). The detection of bF and cF was closely linked to PSA testing frequency ( p < 0.0001). Conclusions: The risk of bF does not appear to decrease >5 years post treatment. Late bF (i.e. >5 years after treatment) may still result in eventual cF. While cF is less common after bF > 5 years post definitive therapy, it still affects 27% of those with bF and is strongly associated with PSA testing frequency. The lower rate of cF after 5 years may relate to the shorter follow-up time for this group.

Predicting return of erectile function following external beam radiotherapy or brachytherapy for prostate cancer using EPIC-CP.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 87-87
Author(s):  
Stephen A. Mihalcik ◽  
Jonathan Chipman ◽  
Martin G. Sanda ◽  
Irving D. Kaplan ◽  
Catrina Crociani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Erectile Function ◽  
Goodness Of Fit ◽  
External Beam Radiotherapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Pearson Residuals ◽  
Patient Reported

87 Background: EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) is a one page, 16-item questionnaire designed and validated to measure patient-reported health related quality of life in prostate cancer (PC) patients at the point of care in the clinical setting. We previously developed and externally validated models predictive of intact sexual function (i.e. achieving an erection firm enough for intercourse) at two years following external beam radiation (EBRT) or brachytherapy (BT) using EPIC-26, the parent tool from which EPIC-CP was derived. We aimed to enable the use of these models in clinical practice by recalibrating them for use with EPIC-CP. Methods: Using a previously described multicenter longitudinal cohort (PROST-QA), we identified 217 men treated with EBRT and 230 with BT with complete sexual domain and model covariate information. We used the established covariates predictive of functional erections in the EPIC-26-based models (baseline sexual score, neoadjuvant hormonal therapy, and baseline PSA for EBRT, and baseline sexual score, age, race, and BMI for BT) to recalibrate the multivariable logistic regression models for use with EPIC-CP. We examined Pearson residuals to determine goodness of fit and compared the individual predictions based on the revised models with those generated by the EPIC-26-based models. Results: The recalibrated EPIC-CP-based models demonstrated excellent discrimination (AUC 0.81 for EBRT, AUC 0.87 for BT). Odds ratio estimates for the EPIC-CP models changed by no more than 0.2 from their EPIC-26 counterparts, and remained statistically significant. EPIC-CP and EPIC-26-based predictions had good concordance: the mean ± SD difference in predicted probability between EPIC-26 and EPIC-CP models was 0.0 ± 0.08 in each treatment group. Predicted probabilities were within 15.4% and 15.8% for 95% of the subjects treated with EBRT and BT, respectively. Conclusions: EPIC-CP-based nomograms predicting erectile function two years after EBRT or BT are in good agreement with established EPIC-26-based tools and offer an easily applied and accurate prediction regarding a common and impactful side effect of PC treatment.

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