Treatment of high-grade low-stage prostate cancer by high-dose-rate brachytherapy

Background and Purpose: The best management of patients with low-stage, hig h-grade prostate cancer remains unclear. In an attempt to improve the outco mes of this high-risk group, we have offered those with Gleason greater tha n or equal to 7 cancers removable-source high-dose-rate (HDR) brachytherapy in combination with external-beam radiation, Patients and Methods: We reviewed the clinical histories of 61 consecutive patients with high-grade clinical stage T-1-T-2 lesions who received the co mbination radiation therapy between March 1997 and November 1998, The avera ge Gleason score was 7.5. The HDR brachytherapy was given in three sessions with removable-source afterloaded Ir-192 to a minimum peripheral dose of 6 Gy, Conformal external-beam radiation in 25 fractions to a dose of 50 Gy w as given beginning 1 week later. Patients with prostate volumes >40 cc rece ived a luteinizing hormone-releasing hormone analog before brachytherapy, Results: Among the 52 patients available for follow-up (average duration 11 .8 months), there has been one death from prostate cancer. After treatment, only one patient had an initial rise in serum prostate specific antigen (P SA) concentration. In addition to the patient who died, there have been thr ee confirmed treatment failures. Toxicity was mild, with only two patients having RTOG grade 3 or 4 effects. Neither of them required surgery. Conclusion: Although long-term results are not available, available data su ggest that HDR brachytherapy plus external-beam radiation is at least as ef fective as any single therapy for high-risk, low-stage prostate cancer. The toxicity is acceptable.