Androgen-deprivation therapy does not impact cause-specific or overall survival after permanent prostate brachytherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 65; no. 3; pp. 669 - 677
• Main Authors: Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Galbreath, Robert W., Allen, Zachariah A., Adamovich, Edward
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2006
• Subjects: Age Factors; Aged; Analysis of Variance; Androgen-deprivation therapy; ANDROGENS; BIOPSY; BRACHYTHERAPY; CARCINOMAS; CARDIOVASCULAR DISEASES; Cause of Death; DEATH; Follow-Up Studies; Humans; Linear Models; Male; METASTASES; Middle Aged; PATIENTS; PROSTATE; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - mortality; Prostatic Neoplasms - radiotherapy; RADIOLOGY AND NUCLEAR MEDICINE; Smoking - adverse effects; Survival; Survival Rate; TOBACCO; Brachytherapy; Androgen-deprivation therapy; Prostate cancer; Survival
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2006.01.030

Purpose: To determine if androgen-deprivation therapy (ADT) has an impact on cause-specific, biochemical progression-free, or overall survival after prostate brachytherapy. Methods and Materials: From April 1995 through June 2002, 938 consecutive patients underwent brachytherapy for clinical Stage T1b to T3a (2002 AJCC) prostate cancer. All patients underwent brachytherapy more than 3 years before analysis. A total of 382 patients (40.7%) received ADT with a duration of 6 months or less in 277 and more than 6 months in 105. The median follow-up was 5.4 years. Multiple clinical, treatment, and dosimetric parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. Results: The 10-year cause-specific, biochemical progression-free, and overall survival rates for the entire cohort were 96.4%, 95.9%, and 78.1%, respectively. Except for biochemical progression-free survival in high-risk patients, ADT did not statistically impact any of the three survival categories. A Cox linear-regression analysis demonstrated that Gleason score was the best predictor of cause-specific survival, whereas percent-positive biopsies, prostate volume, and risk group predicted for biochemical progression-free survival. Patient age and tobacco use were the strongest predictors of overall survival. One hundred two patients have died, with 80 of the deaths a result of cardiovascular disease (54) and second malignancies (26). To date, only 12 patients have died of metastatic prostate cancer. Conclusions: After brachytherapy, androgen-deprivation therapy did not have an impact on cause-specific or overall survival for any risk group; however, ADT had a beneficial effect on biochemical progression-free survival in high-risk patients. Cardiovascular disease and second malignancies far outweighed prostate cancer as competing causes of death.