The outcomes of brachytherapy combined with external beam radiotherapy and hormonal therapy for local high-risk or intermediated-risk prostate cancer

Objective To evaluate the outcomes and complications of permanent brachytherapy combined with external beam radiotherapy and hormonal therapy for local high-risk or intermediated-risk prostate cancer. Methods There were 354 men with local high-risk or intermediated-risk prostate cancer were reviewed, including 111 men with local intermediated-risk prostate cancer and 243 men with local high-risk prostate cancer. The age of the patients were 48 to 84 years old (mean age 72.4 years old). The preoperative PSA levels were in a range of 3.8 to 99.8ng/ml (mean 29.6 g/ml) and the preoperative Gleason scores were 4 to 9 (mean 6.8). The prostate volume were 13.7 to 65.0 ml (mean 30.5 ml). All the patients were treated with brachytherapy combined with hormonal therapy, including 69 patients received additional external beam radiotherapy. All patients were followed up for biochemical progression-free survival (bPFS), distant disease free survival (DDFS), overall survival (OS), cause-specific survival (CSS) rate and complications. Results Among 354 cases, 174 cases underwent brachytherapy after the diagnosis of prostate cancer, and 157 cases underwent brachytherapy after maximal androgen blockade (MAB) treatment for 3 months, while the other 23 patients with large prostate underwent brachytherapy after MAB treatment for 6 months. All 354 cases were treated with MAB after brachytherapy. One hundred and eleven cases in intermediated-risk group were treated with MAB for 6 months and 243 cases in high-risk group were treated with MAB for 6 months to 3 years. Another 69 patients received adjuvant external radiotherapy. All cases were followed up for 9 to 128 months (mean 91 months), including 135 cases having biochemical recurrence, and 63 cases having distant metastasis. There were 81 cases died, including 24 cases died of prostate cancer. The overall bPFS, DDFS, OS and CSS were 61.9%, 82.2%, 77.1% and 93.2% respectively. There were significant difference in the survival rate between the high--risk group and the intermediated-risk group(P<0.001). The incidence of urinary retention and long term urethral stricture were 6.8% and 1.7%, respectively. No serious complications occurred. Conclusion Permanent brachytherapy combined with external beam radiotherapy and hormonal therapy treating local high-risk or intermediated-risk prostate cancer can be effective with few complications. Key words: Prostatic neoplasms; Brachytherapy; Treatment outcome; Postoperative complications