Effectiveness of Brachytherapy Combined with External Beam Radiation Therapy and Hormonal Therapy in Treating Localized High-risk Prostate Cancer

  Objective  To evaluate the effectiveness of brachytherapy combined with external beam radiation therapy and hormonal therapy in treating localized high-risk prostate cancer patients.

  Methods  We retrospectively analyzed 132 prostate cancer patients treated with brachytherapy from December 2003 to December 2007 in Department of Urology, Peking Union Medical College Hospital, including 97 localized high-risk patients, and 35 localized low- to intermediate-risk patients. Postoperative prostate specific antigen (PSA) level was monitored regularly in follow-up visits. Biochemical relapse, progression to castration-resistant prostate cancer (CRPC) or metastasis, and deaths were documented. Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) of the patients were evaluated.

  Results  The bPFS, CSS, and OS of the 132 patients were 83.3%, 91.7%, and 84.8%, respectively; those indexes of the 97 localized high-risk patients were 81.4%, 88.7%, and 81.4%, respectively; and those of the 35 localized low- to intermediate-risk patients were 88.6%, 100%, and 94.3%, respectively. No significant difference was observed in bPFS and OS between high-risk and low-to intermediate-risk patients (P=0.433, 0.098), while CSS was significant higher in low-to intermediate-risk patients than in high-risk patients (P=0.037). After patients were grouped based on Gleason score, tumor-node-metastasis (TNM) clinical stage, or preoperative PSA levels, differences in bPFS among groups were not statistically significant (P=0.084, 0.537, 0.850).

  Conclusion  Brachytherapy combined with external beam radiation therapy and hormonal therapy may effectively control PSA level and delay biochemical relapse in localized high-risk prostate cancer.