MedWire News: Prostate cancer patients aged 55 years or under have excellent biochemical recurrence rates and low toxicity after being treated with 125iodine (125I) brachytherapy (BT), study findings demonstrate.
Disease control rates are commonly thought to be more long-lasting with surgery compared with nonsurgical treatments, report the researchers, and thus surgery is often recommended to younger men.
However, author Juanita Crook (British Columbia Cancer Agency Center for the Southern Interior in Kelowna, Canada) and colleagues write in the journal Urology: “Our experience suggests that for younger men with a strong reluctance to undergo surgery, 125I prostate BT may indeed provide a very effective alternative.”
A cohort of 94 men aged 55 years or below with favorable risk prostate cancer (defined as a prostate-specific antigen [PSA] level of 10 ng/ml or less, a Gleason score of 6 or less, and clinical stage T2a or below), and two with intermediate risk cancer (Gleason score 7), were treated with 125I BT.
After a median follow-up of 63 months, during which time a median number of 12 PSA readings were taken per patient, all 94 patients were alive, and only one had experienced biochemical recurrence – a 2-ng/ml increase in PSA nadir – 36 months after 125I BT.
The men’s genitourinary (GU) and gastrointestinal (GI) toxicity levels, and lower urinary tract symptoms, including erectile function, were measured using the National Cancer Institute Common Terminology Criteria for Adverse Events toxicity scale, and the International Prostate Symptom Score (IPSS) questionnaire, respectively.
A total of nine (9.6%) patients experienced grade 2 acute urinary toxicity, and 11 (11.0%) experienced grade 2 late urinary toxicity with symptoms including frequency, urgency, dysuria, and/or retention, all but one of whom were successfully treated.
The researchers report that the median duration of grade 2 symptoms was 15 months.
Three patients experienced a urethral stricture, classed as a grade 3 GU toxicity, at 7, 18, and 42 months after treatment, and all were corrected with additional treatment.
Only two patients experienced grade 2 GI toxicity (proctitis), and no grade 3 GI toxicity was observed.
The men’s IPSS scores (plus or minus 3 points) returned to baseline scores after an average of 21 months of follow-up, with 10 patients’ symptoms resolving completely. Erectile function was preserved in 87 (94%) of the 93 men who had good functioning at baseline.
“An important deciding factor in radical treatment, for young and old alike, is toxicity,” the researchers conclude. “Our follow-up is long enough for the expression of any late chronic toxicity, the rates for which are acceptably low.”
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