Ten Year Outcomes In Men Under 60 Treated With Iodine-125 Permanent Brachytherapy As Monotherapy

GU - Prostate Cancer: Novel Imaging (MRI,PET) & Brachytherapy

17/09/2014 10:45 Room D-1 Monitor number: 8

M.T. Mason F.R.C.R, S. L. Rodda F.R.C.R., H. Musunuru F.R.C.R.*, N. Collier MBChB, B. Al-Qaisieh Ph.D. †, Peter Bownes M.Sc. †, J. Smith F.R.C.R. ‡, K. Franks F.R.C.R.*, B. Carey F.R.C.R. ‡, D. Bottomley F.R.C.R.*, A. M. Henry F.R.C.R, Departments of *Clinical Oncology, †Medical Physics and ‡Clinical Radiology, Leeds Cancer Centre, St James’s University Hospital, Beckett St, Leeds LS7 7TF, UK.

• Background: Younger men are often advised to have surgery rather than radiation as primary treatment for early prostate cancer owing to concerns about risk of subsequent radiation induced cancer and the lack of effective salvage options post-radiation.

• Aim: Quantify long term outcomes in patients above and below the age of 60 years treated with low dose rate (LDR) permanent prostate seed brachytherapy at single centre in the UK.

• Design, setting and participants: Retrospective audit of prospectively gathered outcomes for 2157 consecutive men treated between Mar 1995 and Sep 2007 in a large public hospital.

• Intervention: Trans-rectal ultrasound (TRUS) guided Iodine-125 brachytherapy delivering 145 Gy using a pre-plan technique. Neo-adjuvant hormonal therapy only for gland cytoreduction. No supplemental external beam radiotherapy.

• Outcomes measures and statistical analysis: Outcome data are reported in terms of overall survival and PSA relapse free survival (Nadir+2 definitions).

• Results: 1582 (73%) patients were ≥60 575 (27%) patients were <60

Median follow up was 6.5 years (range 0.2-17.7)

10 years overall survival was higher in the <60 cohort (86% vs. 75% Log Rank p<0.005)

Stratified by age, death attributed to prostate cancer was:

41 (7.1%) deaths in the <60 cohort

238 (15.0%) deaths in the ≥60 cohort

Total Group (n=2157)

Cohort <60 ( n=575)

Cohort ≥60 (n=1582 )

Age: Median (Range)

64.5 (37-84.9) 57.9 (47.8-59.9) 69.0(60.5-84.9)

Initial PSA: Median (Range)

6.90 (0.4-73) 6.00 (1.5 – 73) 7.10 (0.4 – 63)

Risk Group:

Low 1118 (51.8%) 341 (59.3%) 777 (49.1%)

Intermediate 804 (37.3%) 181 (31.5%) 623 (39.4%)

High 192 (8.9%) 43 (7.5%) 149 (9.4%)

Unknown 43 (2.0%) 10 (1.7%) 33 (2.1%)

D90: Median (Range)

140.5 (59.0-199.9) 140.63 (59.0-195.1) 140.25 (60.2-199.9) Number at risk 1582 1466 1315 1213 1095 966 768 601 474 331 201 112 65 575 528 475 435 398 342 294 224 181 124 87 51 34

Table 1: Patient and treatment characteristics Figure 1: PSA Relapse free survival stratified by age

Number at risk ≥60 149 136 113 98 84 70 49 38 27 19 13 6 4 <60 43 39 33 27 22 20 16 11 11 6 4 3 2

High Risk

Log Rank p=0.31

Number at risk ≥ 60 777 728 656 615 566 504 402 308 245 170 104 56 31 <60 341 322 289 271 252 213 184 138 107 72 45 24 13

Low Risk

Log Rank p=0.05

Number at risk ≥60 623 574 523 480 429 381 312 250 198 141 83 50 30 <60 181 160 147 132 121 107 92 73 61 45 37 24 19

Intermediate Risk

Log Rank p=0.84

Biochemical relapse: 396 (18.4%) of all patients

10 years PSA relapse free survival significantly higher in the under 60 cohort (77% vs. 70% p<0.05)

Low Intermediate High

MSK Risk Group

< 60 yrs≥ 60 yrs

Figure 3: Figure 3: MSK Risk group for patients < 60 years & ≥60 years (a) PSA relapse-free survival according to patient age for Low (b), Intermediate  (c) and high risk patients (d)

a)

b) c) d)

• Conclusion: In this unscreened European population, men under the age of 60 had better outcomes than older men and younger age should not be considered a contraindication for brachytherapy as opposed to surgery.