jstuartd1

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"Ten-Year Biochemical Relapse-Free Survival After External Beam
Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle
Experience"
John Sylvester M.D., John Blasko M.D., Peter Giimm D.O., Robert Meier
M.D., and Judith Malmgren, (PhD)
Copies may be requested to:
John E. Sylvester, M.D., Seattle Prostate Institute, 1101 Madison,
Suite 1101, Seattle, Wash 98115. Tel 206-215-2480. Fax 215-2481.
E-mail: JohnSylvester@seattleprostateInst.com. You might be able to
locate it in the Int. J. Radiation Oncol/Biol. Phys., Vol 57, No.4 pp.
944-952 2003

The bottom line as I read it: This is the first 10-year study done by
a large and recognized center of excellence on the efficacy of IMRT
AND seeds. And, as we had hoped, the 10-yr biochemical relapse-free
survival (BRFS) is a little better than earlier literature and studies
had reported.
Sailor Jack

oitbso

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Here is a copy of the abstract. A key question is what was the median
follow-up time? Maybe he followed them out to 10 years, but he does
mention Kaplan-Meier statistics which may suggest a shorter follow-up.
If median follow-up is 5 years of less, then even this tightened up
version of ASTR0 failure can be pretty forgiving (for example, if
somebody's PSA bounces at around 3 years and then nadirs, and if PSA
is measured yearly, then there is really little or no time left to
fail). In any case, here are the comparable 10 year biochemical
relapse free rates from the Hopkins' RRP nomograms (M. Han, A. W.
Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J.
Urol., 169, 517-523, 2003) for men that would fall into Dr. Blasko's
low-risk group.

T1c psa=4-10 GS=5: 97%
T1c psa=4-10 GS=6: 95%
T2a psa=4-10 GS=5: 96%
T2a psa=4-10 GS=6: 93%
T2b/c psa=4-10 GS=5: 95%
T2b/c psa=4-10 GS=6: 91%

Note that this last group from Hopkins contains T2c men. which the
Blasko team would have placed into their intermediate risk group.
Also, the study is on the small side (232 patients), but it is
informational.

It becomes difficult to compare the Hopkins' nomograms to the
intermediate- and high-risk groups, but I suspect that RT gains an
edge here...Ron


International Journal of Radiation Oncology*Biology*Physics
Volume 57, Issue 4 , 15 November 2003, Paes 944-952
doi:10.1016/S0360-3016(03)00739-9
Copyright © 2003 Elsevier Inc. All rights reserved.
Clinical investigation: prostate
Ten-year biochemical relapse-free survival after external beam
radiation and brachytherapy for localized prost ate cancer: the
Seattle experience
John E. Sylvester M.D. , , *, , John C. Blasko M.D.*, Peter D. Grimm
D.O.*, Robert Meier M.D.* and Judith A. Malmgren Ph.D. , §

* Seattle Prostate Institute at Swedish Hospital, Seattle, WA, USA
Swedish Cancer Center at Stevens Hospital, Edmonds, WA, USA
HealthStat Consulting, Inc., Seattle, WA, USA
§ Department of Epidemiology, University of Washington, Seattle, WA,
USA

Received 21 January 2003; revised 27 May 2003; accepted 4 June 2003.
; Available online 17 October 2003.

Abstract
Purpose
The role of external beam radiation therapy in addition to
brachytherapy continues to be scrutinized for long term control of PSA
levels after prostate cancer diagnosis.
Methods and materials
We report 10-year biochemical relapse-free survival (BRFS) on 232
patients presenting with localized prostate cancer and consecutively
treated with iodine125 (I125) or palladium103 (Pd103) brachytherapy
and neoadjuvant external beam radiation therapy. Multivariate
regression analysis was used to create a pretreatment clinical
prognostic risk model using a modified ASTRO consensus definition (two
consecutive rises in serum PSA) as the outcome. Gleason scoring was
performed by pathologists at a small community hospital. Derived risk
categories are the following: LOW = PSA =< 10 ng/mL, Gleason sum score
<7, and stage <T2c; INTERMEDIATE = PSA >10 ng/mL or Gleason Score >= 7
or stage >= T2c (1 intermediate risk factor); and HIGH = 2 or more
intermediate risk factors. Time to PSA failure (local, distant, or
biochemical) was calculated and compared using Kaplan-Meier plots.
Results
Ten-year BRFS for the entire treatment group was 70%. Biochemical
control rates by risk cohort analysis (95% confidence interval): low
risk, 85% (83.3–90.7%); intermediate risk, 77% (73.0–84.5%); and high
risk, 45% (45.4–57.2%). Using a risk grouping proposed by the Mt.
Sinai group, the BRFS was: low risk, 84%; intermediate risk, 93%; and
high risk, 57%. Grouping by the risk classification used by D'Amico,
the BRFS was: low risk, 86%; intermediate risk, 90%; and high risk,
48%.
Conclusions
I125 or Pd103 brachytherapy, as a boost combined with EBRT, continues
to result in high rates of biochemical control at 10 years. Different
risk group classification schemes lead to different BRFS results.
Author Keywords: Prostatic neoplasms; Radiotherapy; Brachytherapy;
Prostate

Corresponding author. Reprint requests to: John E. Sylvester, M.D.,
Seattle Prostate Institute, 1101 Madison, Suite 1101, , Seattle, WA
98115, , USA. Tel: (206) 215-2480; Fax: (206) 215-2481;