No Benefit Observed From Combined Irradiation in Intermediate-Risk Prostate Cancer


“The addition of external-beam radiotherapy (EBRT) to interstitial brachytherapy failed to reduce prostate cancer progression compared to brachytherapy alone in men with intermediate-risk disease, interim data from a randomized trial showed.

“The 5-year freedom from progression was 84.5% with combined-modality radiotherapy and 85.6% with prostate brachytherapy alone. The odds ratio (OR) for brachytherapy versus combined radiotherapy was 1.09 after a median follow-up of 7.7 years, a difference that did not achieve statistical significance for efficacy or meet the prespecified statistical value to stop the trial for futility.”

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Intermediate Risk Prostate Cancer May Be Well Controlled with Brachytherapy Alone


“For men with intermediate risk prostate cancer, radiation treatment with brachytherapy alone can result in similar cancer control with fewer long-term side effects, when compared to more aggressive treatment that combines brachytherapy with external beam therapy (EBT), according to research presented today at the 58th Annual Meeting the American Society for Radiation Oncology (ASTRO).”

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'Risky': Prostate Radiation, Second Cancers Linked

“External-beam radiation for prostate cancer appears to be tied to the development of secondary cancers.

“Compared with other prostate cancer treatment types, the use of radiotherapy was associated with an increased risk for additional cancers in the lower half of the torso, according to a meta-analysis of 21 studies.

“Specifically, there was an increased risk for cancers of the bladder (adjusted hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.55 – 1.80), colorectum (three studies) (HR, 1.79; 95% CI, 1.34 – 2.38), and rectum (HR, 1.79; 95% CI, 1.34 – 2.38).”

Video: Dr. Higano on Radium-223 for mCRPC

“Celestia S. Higano, MD, FACP, professor of medicine and urology, University of Washington, discusses radium-223 chloride and its efficacy for patients with metastatic castration-resistant prostate cancer (mCRPC).

“Higano says radium-223 (Xofigo), a radium isotope recently approved by the FDA to treat mCRPC, is unique from other therapies in cancer overall. Results from a phase III study showed that patients who received radium-223 had higher overall survival (OS) compared to patients who did not receive the therapy.

“Radium-223 can also benefit patients who may have skeletal metastases, fractures, or require external beam radiation, Higano says.”

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Seeds Top EBRT as Boost Tx in Prostate Cancer

“Low-dose brachytherapy boosts held prostate cancer in check significantly better than dose-escalated external-beam radiation therapy (EBRT) in men with unfavorable-risk disease, a randomized trial showed.

“Patients treated with brachytherapy after androgen deprivation therapy (ADT) and whole-pelvis EBRT had an estimated 9-year relapse-free survival (RFS) of 83% compared with 63% for patients who received a conformal EBRT boost. The difference in favor of brachytherapy emerged after 5 years of follow-up, Scott Tyldesley, MD, of the British Columbia Cancer Agency in Vancouver, reported here at the Genitourinary Cancers Symposium.

” ‘In the context of 12 months of androgen deprivation therapy and whole pelvis external beam radiotherapy, treatment with a low-dose pelvic brachytherapy boost results in a 50% reduction in biochemical relapse compared to dose-escalated EBRT to 78 Gray,’ Tyldesley said. ‘At 6.5 years of follow-up, there was no difference in overall survival, prostate cancer specific survival, or metastasis-free survival.’

“However, ‘there was increased late grade 3 or higher GU toxicity with the low-dose rate boost, a 5% to 6% increase in the prevalence of late GU toxicity,’ he said.”

Majority of Prostate Cancer Patients Surveyed Five Years After Treatment with Vessel-Sparing Radiation Therapy Report Preserved Sexual Function

The gist: A recent scientific study showed that radiation therapy that avoids damaging tissue next to a prostate tumor can be effective and preserve long-term sexual function.

“A comparison of five-year sexual function outcomes, as reported by patients treated with external beam radiotherapy (EBRT) versus combination EBRT plus brachytherapy, indicates that the utilization of vessel-sparing radiation therapy makes cure possible without compromising long-term sexual function, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting.

“The study examined the patient-reported outcomes of 91 men with prostate cancer who received MRI-guided, vessel-sparing radiation at University of Michigan Providence Cancer Institute. The vessel-sparing radiation technique limits the amount of radiation to critical erectile tissues using MRI scans to identify the blood vessels responsible for erections. When radiation dose is limited to these critical structures, the risk of erectile dysfunction is lowered.

“Of the 91 patients studied, all patients received EBRT. Forty-two of the patients received only EBRT (>77.8Gy), and 49 patients received EBRT plus brachytherapy, the implantation of radioactive seeds near the prostate. The combination patients received brachytherapy in the form of an I-125 permanent prostate implant. None of the patients received androgen deprivation therapy (ADT)…

“ ‘In the past, men with prostate cancer expected to pay a high toll in loss of quality of life to achieve cure and were willing to accept that as necessary,’ said lead study author Patrick W. McLaughlin, MD, director of radiation oncology at University of Michigan Providence Cancer Institute in Novi, Mich. ‘This study makes it clear that even with combination radiation protocols, which are capable of curing the majority of prostate cancers more than 90 percent of the time, avoidance of critical adjacent tissues, such as vessel-sparing, makes cure and quality of life an achievable goal for many men.’ ”

Brachytherapy Helps Maintain Erectile Function in Prostate Cancer Patients Without Compromising Treatment Outcomes

“The use of permanent brachytherapy, a procedure where radioactive sources are placed inside the prostate, into or near to the tumour, preserves erectile function in approximately 50% of patients with prostate cancer, a researcher will tell the ESTRO 33 congress today (Saturday).

“Brachytherapy works by giving a high dose of radiotherapy directly to the tumour, but only a very low dose to the surrounding normal tissues. Since erectile dysfunction (ED) can occur in up to 68% of patients who receive external beam radiotherapy for the condition, this is a significant improvement and the treatment should be offered to all patients, particularly those who are sexually active, the researchers say.”

Radiation Combo for High Risk Prostate Cancer Offers Good Outcomes

“Combined brachytherapy and external beam therapy (EBRT) is associated with a high rate of five-year biochemical failure-free survival in men with high-risk prostate cancer (PCa), according to a Japanese study. The study included 206 patients with high-risk PCa treated with iodine-125 brachytherapy and EBRT. Of these, 101 (49%) also received neoadjuvant androgen deprivation therapy (ADT), but no patient received adjuvant ADT. The patients had a median follow-up of 60 months.”

Long-Term ADT, High-Dose Radiation Improved Outcomes in High-Risk Prostate Cancer

“A treatment regimen that consisted of androgen deprivation therapy for 2 or more years plus radiation doses of at least 75.6 Gy significantly improved outcomes in men with high-risk prostate cancer, according to results of a retrospective analysis. Nguyen and colleagues compared outcomes after high-dose (≥75.6 Gy) and low-dose (<75.6 Gy) external beam radiation, with or without androgen deprivation therapy (ADT) in 741 men with high-risk prostate cancer. Men were treated with external beam radiotherapy at a single tertiary institution between 1987 and 2004. Median follow-up was 8.3 years.”