Jaganmohan R. Poli MD, Presenter: Nothing to Disclose

Harsha Varadhi MD, Abstract Co-Author: Nothing to Disclose

John Rutledge MS, Abstract Co-Author: Nothing to Disclose

Dattatreyudu Nori MD, Abstract Co-Author: Nothing to Disclose

The majority of young men with early stage prostate cancer are treated with radical prostatectomy. To determine whether this preference for surgical care is justified we analyzed 5-year biochemical disease-free survival of men with clinically organ-confined prostate cancer treated with external beam irradiation (XRT) or transperineal ultrasound guided permanent prostate brachytherapy (BRT).

Forty patients with a mean age of 52 years (range 43 - 55) were treated with definitive radiation therapy from April 1991 to April 2005. Two patients were excluded from the final analysis because of early onset of distant disease. The final analysis included 38 patients. All patients had clinical stage T1c to T2c adenocarcinoma of the prostate. Based on initial PSA level and biopsy Gleason scores (GS) patients were placed one of the three risk cohorts: low risk cohort (GS = 6 & PSA = 10); intermediate risk (GS 7 or PSA >10 & =20) and high risk (GS 8-10 or PSA >20). Based on this risk stratification 19 (50%), 9 (23.7%) and 10 (26.3%) patients were in the low, intermediate and high risk cohorts. Sixteen (42%) patients were treated with XRT (70.2 to 81 Gy) with 3D conformal radiation or Intensity modulated techniques. Thirteen (34%) patients were treated with XRT to 45 Gy followed by BRT with either 103Pd or 125 I. Nine (24%) patients underwent BRT alone with either 103Pd or 125I. The median follow - up was 54.7 months (range 6.8 - 141.7 months). Follow -up was calculated from the day of initial contact. Biochemical relapse-free survival (bRFS) and overall survival were calculated using Kaplan-Meier plots. Biochemical disease-free survival was defined as a rise by 2 ng/ml or more above the nadir PSA (Phoenix definition).

5-year bRFS for the entire treatment group was 74.7%, bRFS using the risk cohort analysis: low risk 94.1 %; intermediate risk 60% & high risk 54.9%. Grade 3 chronic bladder and bowel toxicity was noted in 3 (8 %) & 2 (6%) of patients respectively which was managed conservatively. No grade 4 toxicity or urinary incontinence was reported. Thirty two patients (84%) reported sexual potency as “good” prior to treatment. Twenty one patients (66%) reported “good” potency after treatment.

Our analysis of this small group of men younger than 55 yrs showed that the bRFS in this age group is comparable to the results reported in older men with similar presentation and who were treated with either radiation or prostatectomy. The potency preservation rate and long term bladder and bowel toxicity also appears to be acceptable.

Poli, J, Varadhi, H, Rutledge, J, Nori, D, The Role of Radiotherapy in Men under 55 Years of Age with Localized Prostate Cancer.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/6000513.html