Photo Credit: Mariam Arsaliaa

The following is a summary of “LDR-Brachytherapy monotherapy appears unsuited for NCCN unfavorable intermediate-risk prostate cancer patients,” published in the November 2023  issue of Urology by Boehle, et al.

For a study, researchers sought to check if dividing intermediate-risk (IR) prostate cancer into favorable intermediate-risk (FIR) and unfavorable intermediate-risk (UIR) PCa is correct in a group of past patients and to see how two different treatment plans worked. They looked back at patients with intermediate-risk (IR) PCa who were treated with either ¹²⁵J-LDR-brachytherapy monotherapy (BT) or combined-modality radiation therapy (CRT). They were then divided into FIR and UIR groups and re-evaluated for biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS), and prostate cancer-specific survival (CSS). 

The Kaplan-Meier product-limit method and the log-rank tests were used to determine the survival chances and compare survival rates. Cox proportional hazard regression was used for both univariable and multivariate studies. Of 490 people with IR, 252 had BT (86.5% FIR, 13.5% UIR), and 238 had CRT (30% FIR, 70% UIR). Looking back, they saw that at 10 years, BRFS was 81% for BT and 94% for CRT in FIR patients. At 10 years, BT had a 37% BRFS rate for UIR patients and 89% for CRT. At 10 years, 87% of FIR patients who had BT and 94% of those who had CRT had met their MFS goals. 

At 10 years, MFS for UIR patients with BT was 78%, and CRT was 95%. The treatment (BT vs. CRT) was the only factor that was linked to biochemical recurrence and tumors in the UIR group (BFRS, P < 0.001, HR 16.07 (CI 4.23–61.10); MFS, P = 0.011, HR 8.43 (CI 1.62–43.9). It looks like IR prostate cancer needs to be broken down into FIR and UIR groups. The results of BT monotherapy were good for FIR patients. However, the rate of clinical failure after ¹²⁵J-LDR-BT was much higher in UIR patients, which suggests that BT alone was less effective in this high-risk group. On the other hand, UIR patients who had CRT had a great result.

Source: sciencedirect.com/science/article/abs/pii/S107814392300282X