Is modern external beam radiotherapy with androgen deprivation therapy still a viable alternative for prostate cancer in an era of robotic surgery and brachytherapy: A comparison of Australian series

• Published in: Journal of medical imaging and radiation oncology Vol. 59; no. 1; pp. 125 - 133
• Main Authors: Wilcox, Shea William, Aherne, Noel J., McLachlan, Craig Steven, McKay, Michael J., Last, Andrew J., Shakespeare, Thomas P.
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.02.2015; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Androgen Antagonists - therapeutic use; Australia - epidemiology; brachytherapy; Brachytherapy - mortality; Cancer therapies; Chemoradiotherapy - mortality; Disease-Free Survival; external beam radiotherapy; Humans; intensity-modulated radiotherapy prostate cancer; Male; Middle Aged; Prevalence; Prostate cancer; Prostatic Neoplasms - therapy; Radiation therapy; radical prostatectomy; Radiotherapy, Conformal - mortality; Retrospective Studies; Risk Factors; Robotics - statistics & numerical data; Surgery; Surgery, Computer-Assisted - mortality; Survival Rate; Treatment Outcome; Australia; external beam radiotherapy; intensity-modulated radiotherapy prostate cancer; radical prostatectomy; brachytherapy
• ISSN: 1754-9477; 1754-9485
• DOI: 10.1111/1754-9485.12275

Introduction We compare the results of modern external‐beam radiotherapy (EBRT), using combined androgen deprivation and dose‐escalated intensity‐modulated radiotherapy with MRI‐CT fusion and daily image guidance with fiducial markers (DE‐IG‐IMRT), with recently published Australian series of brachytherapy and surgery. Methods Five‐year actuarial biochemical disease‐free survival (bDFS), metastasis‐free survival (MFS) and prostate cancer‐specific survival (PCaSS) were calculated for 675 patients treated with DE‐IG‐IMRT and androgen deprivation therapy (ADT). Patients had intermediate‐risk (IR) and high‐risk (HR) disease. A search was conducted identifying Australian reports from 2005 onwards of IR and HR patients treated with surgery or brachytherapy, reporting actuarial outcomes at 3 years or later. Results With a median follow‐up of 59 months, our 5‐year bDFS was 93.3% overall: 95.5% for IR and 91.3% for HR disease. MFS was 96.9% overall (99.0% IR, 94.9% HR), and PCaSS was 98.8% overall (100% IR, 97.7% HR). Prevalence of Grade 2 genitourinary and gastrointestinal toxicity at 5 years was 1.3% and 1.6%, with 0.3% Grade 3 genitourinary toxicity and no Grade 3 gastrointestinal toxicity. Eight reports of brachytherapy and surgery were identified. The HDR brachytherapy series' median 5‐year bDFS was 82.5%, MFS 90.0% and PCaSS 97.9%. One surgical series reported 5‐year bDFS of 65.5% for HR patients. One LDR series reported 5‐year bDFS of 85% for IR patients. Conclusions Modern EBRT is at least as effective as modern Australian surgical and brachytherapy techniques. All patients considering treatment for localised prostate cancer should be referred to a radiation oncologist to discuss EBRT as an equivalent option.