Interstitial low dose rate brachytherapy for prostate cancer--a focus on intermediate- and high-risk disease

AimsTo investigate the role of brachytherapy in intermediate- and high-risk prostate cancer. We report our results and a review of published studies.Materials and methodsBetween March 1999 and April 2003, 300 patients were treated with low dose rate I-125 interstitial prostate brachytherapy and followed prospectively. The patients were stratified into low-, intermediate- and high-risk groups and received brachytherapy alone or in combination with external beam radiotherapy (EBRT) and/or neoadjuvant androgen deprivation (NAAD). One hundred and forty-six patients were classified as low risk, 111 as intermediate risk and 43 as high risk. Biochemical freedom from disease and prostate-specific antigen (PSA) nadirs were analysed for risk groups and for treatment received in each risk group.ResultsThe median follow-up was 45 months (range 33–82 months) with a mean age of 63 years. Actuarial 5-year biochemical relapse-free survival for the low-risk group was 96%, 89% for the intermediate-risk group and 93% for the high-risk group. When stratified by treatment group, low-risk patients had a 5-year actuarial biochemical relapse-free survival of 94% for brachytherapy alone (n = 77), 92% for NAAD and brachytherapy (n = 66) and 100% for NAAD, EBRT and brachytherapy (n = 3). In the intermediate-risk patients, biochemical relapse-free survival was 93% for brachytherapy alone (n = 15), 94% for NAAD and brachytherapy (n = 67), 75% for EBRT and brachytherapy (n = 4) and 92% for NAAD, EBRT and brachytherapy (n = 25). In the high-risk group, biochemical relapse-free survival was 100% for brachytherapy alone (n = 2), 88% for NAAD and brachytherapy (n = 7), 80% for EBRT and brachytherapy (n = 5) and 96% for NAAD, EBRT and brachytherapy (n = 29). Overall 3- and 4-year PSA = 0.5 ng/ml were achieved by 71 and 86%, respectively, and a 4-year PSA = 0.2 ng/ml was achieved by 63%.ConclusionAlthough the role of combination treatment with pelvic EBRT and androgen therapy is not clear, our early results show that many patients with intermediate- and high-risk disease have excellent results with brachytherapy.