NYPI PUBLICATIONS
Long-term Multi-Institutional Outcome and biochemical Failure Definition Analysis of Combined Permanent Brachytherapy With External Beam Radiation for Prostate Cancer
- M. A. Elshaikh1, D. Kuban2, L. Levy2, L. Potters3, J. Blasko4, D. Beyer5, A. Zietman6, B. J. Moran7, J. Ciezki8, M. J. Zelefsky9, et al. 1University of Michigan, Ann Arbor, MI, 2University of Texas MD Anderson Cancer Center, Houston, TX, 3New York Prostate Institute, Oceanside, NY, 4Seattle Prostate Institute, Seattle, WA, 5Arizona Oncology Services, Scottsdale, AZ, 6Massachusetts General Hospital, Boston, MA, 7Chicago Prostate Institute, Chicago, IL, 8Cleveland Clinic Foundation, Cleveland, OH, 9Memorial Sloan Kettering Cancer Center, New York, NY
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Customized Dose Prescription for Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes
- N. N. Stone1, L. Potters2, B. J. Davis3, J. P. Ciezki4, M. J. Zelefsky5, M. Roach6, P. A. Fearn5, M. W. Kattan7, R. G. Stock1 1Mount Sinai School of Medicine, New York, NY, 2New York Prostate Institute at South Nassau Communities Hospital, Oceanside, NY, 3Mayo Clinic, Rochester, MN, 4Cleveland Clinic, Cleveland, OH, 5Memorial Sloan Kettering CancerCenter, New York, NY, 6University of California at San Francisco, San Francisco, CA, 7Cleveland Clinic Foundation,Cleveland, OH
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An Updated 9-Year Preoperative Nomogram Predicting for Prostate Cancer Recurrence After Permanent Prostate Brachytherapy
- M. W. Kattan1, R. G. Stock2, J. P. Ciezki3, B. J. Davis4, M. J. Zelefsky5, M. Roach6, N. N. Stone2, P. A. Fearn5, L. Potters7. 1Cleveland Clinic Foundation, Cleveland, OH, 2Mount sinai School of Medicine, New York, NY, 3Cleveland Clinic,Cleveland, OH, 4Mayo Clinic, Rochester, MN, 5Memorial Sloan Kettering Cancer Center, New York, NY, 6University of california at San Francisco, San Francisco, CA, 7New York Prostate Institute at South Nassau Communities Hospital, Oceanside, NY
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The Post-Treatment PSA Bounce for Prostate Cancer Patients Treated With External Beam RT or Permanent Brachytherapy Alone Is Not Biochemically or Clinically Significant: A Multi-Institutional Pooled A
- E. M. Horwitz1, L. B. Levy2, A. A. Martinez3, L. Potters4, D. C. Beyer5, J. C. Blasko6, H. M. Sandler7, S. J. Buskirk8, A. L. Zietman9, D. A. Kuban2. 1Fox Chase Cancer Center, Philadelphia, PA, 2M.D. Anderson Cancer Center, Houston, TX, 3William Beaumont Hospital, Royal Oak, MI, 4New York Prostate Institute, Oceanside, NY, 5Arizona Oncology Services, Scottsdale, AZ, 6Seattle Prostate Institute, Seattle, WA, 7University of Michigan, Ann Arbor, MI, 8Mayo Clinic College of Medicine, Jacksonville, FL,9Massachusetts General Hospital, Boston, MA
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Postoperative Nomogram Predicting the 9-Year Probability of Prostate Cancer Recurrence After Permanent Prostate Brachytherapy
- L. Potters1, R. G. Stock2, J. P. Ciezki3, B. J. Davis4, M. J. Zelefsky5, M. Roach6, N. N. Stone2, P. A. Fearn5, M. W. Kattan7. 1New York Prostate Institute at South Nassau Communities Hospital, Oceanside, NY, 2Mount Sinai School of Medicine, New York, NY, 3Cleveland Clinic, Cleveland, OH, 4Mayo Clinic, Rochester, MN, 5Memorial Sloan Kettering Cancer Center, New York, NY, 6University of California at San Francisco, San Francisco, CA, 7Cleveland Clinic Foundation, Cleveland, OH
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Purpose/Objective(s): Questions remain regarding the biochemical and clinical significance of the post-treatment PSA bounce in patients treated with external beam radiation therapy (RT) or implants (BT). The purpose of this report was to determine if there was a difference in biochemical and clinical control between the bounce and non-bounce (NB) patients using pooled data on 7532 patients from 2 multi-institutional pooled datasets- 4839 patients with T1-2 prostate cancer treated with RT alone and 2693 patients treated with BT alone and identify any predictors of a bounce.
Materials/Methods: For patients treated with RT, 9 institutions pooled data on 4839 treated between 1989-1995. 11 institutions pooled data on 2693 patients treated between 1988-1998 with a permanent implant alone [1831 patients were treated with I-125 (median dose:160 Gy) and 862 patients (32%) were treated with Pd-103 (median dose: 120 Gy)]. No neoadjuvant androgen ablation was allowed. A post-tx PSA bounce was defined as an increase of at least 0.2 ng/ml over a previous PSA measurement followed by a decline. The median follow-up for the RT and BT patients were 75 and 63 months, respectively. Endpoints included bNED failure (nadir _ 2), distant metastases-free survival (DMFS), cause-specific survival (CSS) and overall survival (OS). Patients were stratified by pre-tx PSA level, Gleason score (GS), T stage, age (_ 70 vs. _ 70), RT dose, isotope, D90 and risk group [low risk (group 1)- T1-2a, GS _ 6 and PSA _ 10 ng/ml; intermediate risk (group 2)-T1-2a, GS _ 7, or PSA 10-20 ng/ml, T2b-c,GS _ 7 and PSA _ 20 ng/ml; high risk (group 3)- GS 8-10 or PSA _ 20 ng/ml].
Results: 902 patients (18.6%) treated with RT and 470 patients (17.5%) treated with BT experienced at least one post-tx PSA bounce. For the RT patients, pre-treatment PSA, T stage and age were predictors of bounce. Age and isotope predicted bounce for the BT patients at 5 years (78.4% bounce free _ 70 years vs. 82.3% bounce free _ 70 years, p _ 0.02, 78.1% bounce free I-125 vs. 82.6% bounce free Pd-103, p _ 0.04). Patients at risk for a biochemical or clinical failure at 3 years (had not failed and under observation) and were classified as having achieved a bounce or NB by 3 years, the NB patients had 53% bNED control at 10 years compared to 55% for the bounce patients (p _ 0.83). For the BT patients with at least 3 years of follow-up, the NB patients had 72% bNED control at 10 years compared to 62% for the bounce patients (p _ 0.26). At 10 years, there were no statistically significant differences in DMFS, CSS and OS between the NB and bounce RT patients [DMFS- 93.9% vs. 94.5% (p _ 0.16); CSS- 91.7% vs. 93.2% (p _ 0.21); OS- 64.5% vs. 67.5% (p _ 0.10)] or BT patients [DMFS- 94.5% vs. 96.9% (p _ 0.74); CSS- 94.3% vs. 96.3% (p _ 0.56); OS- 62.5% vs. 66.3% (p _ 0.22)].
Conclusions: In this multi-institutional analysis with large patient numbers and long follow-up, patients treated with either RT alone or BT alone who experience a post-tx PSA bounce do not have increased risk of biochemical or clinical failure compared to men who do not bounce at 10 years. BT patients treated with I-125 bounce more often than patients who receive Pd-103. Younger men (_ 70 years) treated with either modality bounce more frequently but there is no difference in outcome.
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