PURPOSE: We analyzed the factors influencing 15-year cause-specific (CSS) and all-cause survival (ACS) in men treated by prostate brachytherapy (PB).
MATERIALS AND METHODS: 1669 men with T1-T3 prostate cancer with a median age of 66 years were treated with PB and followed a mean of 10 years. Treatments were implant alone, implant plus hormone therapy (HT) or external beam irradiation (EBRT) or implant plus HT plus EBRT. HT was administered to 898 (53.8%) men a median of 6 months. Estimates for CSS and ACS were determined by Kaplan Meier method with comparisons by logistic regression and Cox proportions hazard rates.
RESULTS: 15-year CSS was 94.1%. CSS by the 3 NCCN risk groups was 96.3%, 97.5% and 85.2% (p< 0.001). HT did not positively impact CSS. 15-year ACS was 57% and Cox regression demonstrated age (p< 0.001, HR 1.09), HT (p=0.032, HR 1.04), diabetes (p=0.013, HR 1.86), atrial fibrillation (p=0.041, HR 2.90), smoking (p=0.030, HR 1.42) and emphysema (p=0.040, HR 8.20) as significant associations. HT decreased ACS at 15 years from 60.3% to 54.9% (p=0.009). ACS was not reduced if HT was limited to < 6 months (p=0.005). This difference was present in both younger (age < 66, p=0.017) and older men (p=0.05).
CONCLUSIONS: PB yields favorable 15-year CSS, especially in high risk patients. ACS is less in patients with preexisting diabetes, atrial fibrillation and emphysema. 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.
Written by:
Stone NN, Stock RG. Are you the author?
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Reference: J Urol. 2014 Mar 31. pii: S0022-5347(14)03182-6.
doi: 10.1016/j.juro.2014.03.094
PubMed Abstract
PMID: 24698961
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