Extended Follow-Up of Patients with Stage T2a Prostate Adenocarcinoma After Outpatient Conformal Brachytherapy: Risk Stratification for Treatment Optimization

Brachytherapy is an excellent definitive treatment modality for select patients with localized prostate cancer. Sixty-four patients with Stage T2a prostate adenocarcinoma were identified from the series of prostate patients receiving conformal outpatient brachytherapy between 1990 and 1997. Pretreatment Gleason scores and prostate specific antigen (PSA) values ranged from 2 to 10 and 1.5 to 100, respectively. Median follow-up was 48.5 months. The 5-year overall survival rate was 82.5%, whereas the cause-specific survival rate was 93.7%. The biochemical freedom-from-relapse (bFFR), defined as a PSA level of ≤ 1.0 for patients presenting with Gleason scores of ≤ 5, was 68%; 80% with Gleason scores of ≤ 5 and presenting PSA levels of ≤ 10. In patients with Gleason scores of 6 at presentation, the overall bFFrR was 67%; 87% with a Gleason scores of 6 and PSA levels of ≤ 10. The bFFR was maintained in more than half of patients with Gleason scores of 7 only if they presented with PSA levels of ≤ 10. All patients who presented with PSA levels of ≤ 10 had bFFRs of 75%, compared to 36% for those patients presenting with PSA levels of > 10. These data show that patients with Gleason scores of ≤ 5 can achieve very good PSA control with brachytherapy, especially if the presenting PSA level is ≤ 10. Consideration of PSA is of greater import when a Gleason score ≥ 6 is encountered at presentation. Our data show that durable bFFR can be achieved in patients presenting with Stage T2a disease, Gleason scores of 5–7, and PSA levels of ≤ 10. These results need to be confirmed with further follow-up and other prospective data.