Neoadjuvant androgen ablation combined with external-beam radiation therapy and permanent interstitial brachytherapy boost in localized prostate cancer

Androgen ablation therapy has been combined with permanent interstitial bra chytherapy in order to downsize the gland prior to seed implantation. It al so has been employed in an attempt to improve the effectiveness of therapy in patients with a poor prognosis. We report on 50 patients consecutively t reated and prospectively followed. All received neoadjuvant hormonal therap y (NHT) and 45 Gy of external-beam therapy to a limited pelvic field, follo wed by permanent implantation of I-125 or Pd-103 seeds. The median follow-u p is 42.1 months (range 9.0-90.8 months). The prostate specific antigen (PS A) progression-free survival rate (<1.0 ng/mL) was 76% at 5 years (Kaplan-M eier method). Local control was achieved in 100% of the patients and distan t disease-free survival in 85%, High-risk patients treated contemporaneousl y with these patients, who received external-beam radiation and a seed boos t without NHT, had a 62% rate of 5-year PSA progression-free survival. Alth ough the modest improvement in PSA progression-free survival is not statist ically significant at 5 Sears (P = 0.5), the patients treated with NHT in a ddition to combined radiotherapy presented with significantly higher serum PSA concentrations (mean 21.0 ng/mL; median 17.0 ng/mL) than those treated with combination radiotherapy alone (mean 15.6 ng/mL; median 10.6 ng/mL) an d thus had a worse prognosis.