NYPI PUBLICATIONS
Long-term Multi-Institutional Outcome and biochemical Failure Definition Analysis of Combined Permanent Brachytherapy With External Beam Radiation for Prostate Cancer
- M. A. Elshaikh1, D. Kuban2, L. Levy2, L. Potters3, J. Blasko4, D. Beyer5, A. Zietman6, B. J. Moran7, J. Ciezki8, M. J. Zelefsky9, et al. 1University of Michigan, Ann Arbor, MI, 2University of Texas MD Anderson Cancer Center, Houston, TX, 3New York Prostate Institute, Oceanside, NY, 4Seattle Prostate Institute, Seattle, WA, 5Arizona Oncology Services, Scottsdale, AZ, 6Massachusetts General Hospital, Boston, MA, 7Chicago Prostate Institute, Chicago, IL, 8Cleveland Clinic Foundation, Cleveland, OH, 9Memorial Sloan Kettering Cancer Center, New York, NY
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Customized Dose Prescription for Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes
- N. N. Stone1, L. Potters2, B. J. Davis3, J. P. Ciezki4, M. J. Zelefsky5, M. Roach6, P. A. Fearn5, M. W. Kattan7, R. G. Stock1 1Mount Sinai School of Medicine, New York, NY, 2New York Prostate Institute at South Nassau Communities Hospital, Oceanside, NY, 3Mayo Clinic, Rochester, MN, 4Cleveland Clinic, Cleveland, OH, 5Memorial Sloan Kettering CancerCenter, New York, NY, 6University of California at San Francisco, San Francisco, CA, 7Cleveland Clinic Foundation,Cleveland, OH
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An Updated 9-Year Preoperative Nomogram Predicting for Prostate Cancer Recurrence After Permanent Prostate Brachytherapy
- M. W. Kattan1, R. G. Stock2, J. P. Ciezki3, B. J. Davis4, M. J. Zelefsky5, M. Roach6, N. N. Stone2, P. A. Fearn5, L. Potters7. 1Cleveland Clinic Foundation, Cleveland, OH, 2Mount sinai School of Medicine, New York, NY, 3Cleveland Clinic,Cleveland, OH, 4Mayo Clinic, Rochester, MN, 5Memorial Sloan Kettering Cancer Center, New York, NY, 6University of california at San Francisco, San Francisco, CA, 7New York Prostate Institute at South Nassau Communities Hospital, Oceanside, NY
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The Post-Treatment PSA Bounce for Prostate Cancer Patients Treated With External Beam RT or Permanent Brachytherapy Alone Is Not Biochemically or Clinically Significant: A Multi-Institutional Pooled A
- E. M. Horwitz1, L. B. Levy2, A. A. Martinez3, L. Potters4, D. C. Beyer5, J. C. Blasko6, H. M. Sandler7, S. J. Buskirk8, A. L. Zietman9, D. A. Kuban2. 1Fox Chase Cancer Center, Philadelphia, PA, 2M.D. Anderson Cancer Center, Houston, TX, 3William Beaumont Hospital, Royal Oak, MI, 4New York Prostate Institute, Oceanside, NY, 5Arizona Oncology Services, Scottsdale, AZ, 6Seattle Prostate Institute, Seattle, WA, 7University of Michigan, Ann Arbor, MI, 8Mayo Clinic College of Medicine, Jacksonville, FL,9Massachusetts General Hospital, Boston, MA
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Postoperative Nomogram Predicting the 9-Year Probability of Prostate Cancer Recurrence After Permanent Prostate Brachytherapy
- L. Potters1, R. G. Stock2, J. P. Ciezki3, B. J. Davis4, M. J. Zelefsky5, M. Roach6, N. N. Stone2, P. A. Fearn5, M. W. Kattan7. 1New York Prostate Institute at South Nassau Communities Hospital, Oceanside, NY, 2Mount Sinai School of Medicine, New York, NY, 3Cleveland Clinic, Cleveland, OH, 4Mayo Clinic, Rochester, MN, 5Memorial Sloan Kettering Cancer Center, New York, NY, 6University of California at San Francisco, San Francisco, CA, 7Cleveland Clinic Foundation, Cleveland, OH
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Purpose/Objective(s): To assess biochemical failure definitions (BFD) and long-term prostate-specific antigen (PSA) outcome after permanent prostate brachytherapy (BT) combined with external beam radiation treatment (EBRT) for patients (pts) with T1-T2 prostate cancer.
Materials/Methods: Eleven institutions combined data on 527 pts treated with combination of EBRT and BT and 2693 pts treated with BT monotherapy, the latter being used as a comparative group. Criteria for inclusion were: stage T1-T2, pre-treatment PSA, therapy 5 years before data collection (1988-1998), and no androgen suppression prior to failure. Prognostic groups were defined according to the National Comprehensive Cancer Network. Based on our prior work, multiple candidate PSA failure definitions appropriate for EBRT and BT alone were tested on the BT _ EBRT group for their ability to predict clinical failure.
Results: Median follow-up was 4.7 years for EBRT _ BT pts and 5.2 years for BT alone pts. 31% of EBRT _ BT pts were implanted with I-125 at a median dose of 120 Gy and 69% were treated with Pd-103 at a median dose of 90 Gy. BT doses were all pre TG-43. Median dose for EBRT was 45 Gy. 68% of BT only pts were implanted with I-125 at a median dose of 160 Gy and the remainder with Pd-103 at a median dose of 120 Gy. On regression analysis, similar to EBRT and permanent prostate brachytherapy alone, the nadir _2 ng/ml PSA failure definition fit the data best, with sensitivity and specificity of 65% and 91% versus 32% and 95% for 3 consecutive PSA rises (ASTRO without backdating). The surgical type definitions, such as an absolute PSA level of 0.2 ng/ml or 0.5 ng/ml, had high sensitivities but low specificities, although specificities were better than when using those definitions for external beam or brachytherapy alone. Using nadir _ 2 ng/ml failure definition, 7-year freedom from PSA failure was 93%, 75% and 50% for patients with low, intermediate and high risk disease, respectively. For low risk patients treated with BT alone and D90s _/_ 140 Gy for I-125 and _/_ 105 Gy for Pd-103, 7-year PSA disease-free survival (PSADFS) was 90% and 87% respectively, and not significantly different from pts treated with EBRT _ BT. For the intermediate risk group, multivariate analysis showed that stage, Gleason score, PSA, and treatment year were significant variables, but not isotope nor treatment (EBRT _ BT vs BT alone). Since the hazard ratio for PSA failure is slightly higher (1.2) for BT alone and the intermediate risk group is somewhat heterogeneous, further analysis of particular subgroups is necessary as is the effect of D90. High risk patients did poorly with either treatment method.
Conclusions: The current nadir _ 2 ng/ml biochemical failure definition is well suited to patients treated with EBRT _ BT, and therefore, this BFD provides a uniform method to assess biochemical failures in pts treated with EBRT and/or BT. In patients with minimum follow-up _/_ 5-6 years, defining biochemical failure as exceeding an absolute PSA level of 0.5 ng/ml may be reasonable. While low risk patients did equally as well with brachytherapy alone, and high risk patients did poorly with either treatment method, whether supplemental external beam radiation is beneficial for the intermediate risk group, or perhaps certain subgroups, may be best answered by a randomized trial
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