Gleason 7 prostate cancer treated with low-dose-rate brachytherapy: lack of impact of primary Gleason pattern on biochemical failure

作者：Stock Richard G^*; Berkowitz Joshua; Black**urg Seth R; Stone Nelson N

来源：BJU International, 2012, 110(9): 1257-1261.

DOI：10.1111/j.1464-410X.2012.11057.x

• prostate cancer
• Gleason score 7
• primary Gleason grade
• brachytherapy

OBJECTIVES
To report the biochemical outcomes for Gleason 7 prostate cancer treated with brachytherapy.
To analyse the impact of the primary Gleason pattern as well as other disease- and treatment-related factors on outcome.
PATIENTS AND METHODS
A total of 560 patients with Gleason 7 prostate cancer were treated between 1990 and 2008 with brachytherapy, alone or in combination with hormonal therapy and/or external beam radiation therapy.
There were 352 patients with Gleason pattern 3+4 and 208 with Gleason pattern 4+3.
The mean (range) presenting PSA level was 11.2 (1-300) ng/mL, and the median was 7.8 ng/mL.
The presenting clinical stages were T1b in 1%, T1c in 33%, T2a in 16%, T2b in 32%, T2c in 16% and T3 in 2% of patients.
RESULTS
The actuarial freedom from biochemical failure rate at 10 years was 82%.
There was no significant difference between 10-year freedom from biochemical failure rates for patients with Gleason scores of 3+4 (79%) and those with scores of 4+3 (82%).
Biologically effective dose and presenting PSA level were both significant predictors of biochemical failure in multivariate analysis.
CONCLUSIONS
The primary Gleason pattern in Gleason 7 prostate cancer shows no significant effect on biochemical failure when treated with brachytherapy.
These results are different from those found after radical prostatectomy and are probably attributable to the enhanced local control afforded by a brachytherapy approach to this disease subset.

• 出版日期2012-11