Large prostate gland size is not a contraindication to low-dose-rate brachytherapy for prostate adenocarcinoma

Kosj Yamoah, Harriet B. Eldredge-Hindy, Nicholas Zaorsky, Joshua D. Palmer, Laura A. Doyle, Jocelyn A. Sendecki, Adam A. Hesney, Logan Harper, Michael Repka, Timothy N. Showalter, Mark D. Hurwitz, Adam P. Dicker, Robert B. Den

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Abstract

Purpose: Prostate volume greater than 50. cc is traditionally a relative contraindication to prostate seed implantation (PSI), but there is little consensus regarding prostate size and clinical outcomes. We report biochemical control and toxicity after low-dose-rate PSI and compare outcomes according to the prostate size. Methods and Materials: A total of 429 men who underwent low-dose-rate PSI between 1998 and 2009 were evaluated. Median followup was 38.7 months. Patients were classified by prostate volume into small, medium, and large subgroups. Differences were analyzed using the Mann-Whitney and Pearson's χ2 tests for continuous and categorical variables, respectively. Cox proportional hazards regression models were used to evaluate effect of prostate size on outcomes. Results: Patient pretreatment factors were balanced between groups except for age (p=0.001). The 10-year actuarial freedom from biochemical failure for all patients treated with PSI was 96.3% with no statistically significant difference between large vs. small/medium prostate size (90% vs. 96.6%, p=0.47). In a multivariate analysis, plan type (hazard ratio [HR]=0.25, p=0.03), dose to 90% of the gland (D90: HR=0.98, p=0.02), volume receiving 200Gy (V200: HR=0.98, p=0.026), and biologic effective dose (HR=0.99, p=0.045), but not prostate size (HR=2.27, p=0.17) were significantly associated with freedom from biochemical failure. Prostate size was not significantly associated with time to maximum American Urologic Association score. Conclusion: In men with large prostates, the PSI provides biochemical control and temporal changes in genitourinary toxicity that are comparable with men having smaller glands. Accurate dose optimization and delivery of PSI provides the best clinical outcomes regardless of gland size.

Original languageEnglish (US)
Pages (from-to)456-464
Number of pages9
JournalBrachytherapy
Volume13
Issue number5
DOIs
StatePublished - Jan 1 2014

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Brachytherapy
Prostate
Adenocarcinoma
Seeds
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Yamoah, K., Eldredge-Hindy, H. B., Zaorsky, N., Palmer, J. D., Doyle, L. A., Sendecki, J. A., ... Den, R. B. (2014). Large prostate gland size is not a contraindication to low-dose-rate brachytherapy for prostate adenocarcinoma. Brachytherapy, 13(5), 456-464. https://doi.org/10.1016/j.brachy.2014.04.003
Yamoah, Kosj ; Eldredge-Hindy, Harriet B. ; Zaorsky, Nicholas ; Palmer, Joshua D. ; Doyle, Laura A. ; Sendecki, Jocelyn A. ; Hesney, Adam A. ; Harper, Logan ; Repka, Michael ; Showalter, Timothy N. ; Hurwitz, Mark D. ; Dicker, Adam P. ; Den, Robert B. / Large prostate gland size is not a contraindication to low-dose-rate brachytherapy for prostate adenocarcinoma. In: Brachytherapy. 2014 ; Vol. 13, No. 5. pp. 456-464.
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title = "Large prostate gland size is not a contraindication to low-dose-rate brachytherapy for prostate adenocarcinoma",
abstract = "Purpose: Prostate volume greater than 50. cc is traditionally a relative contraindication to prostate seed implantation (PSI), but there is little consensus regarding prostate size and clinical outcomes. We report biochemical control and toxicity after low-dose-rate PSI and compare outcomes according to the prostate size. Methods and Materials: A total of 429 men who underwent low-dose-rate PSI between 1998 and 2009 were evaluated. Median followup was 38.7 months. Patients were classified by prostate volume into small, medium, and large subgroups. Differences were analyzed using the Mann-Whitney and Pearson's χ2 tests for continuous and categorical variables, respectively. Cox proportional hazards regression models were used to evaluate effect of prostate size on outcomes. Results: Patient pretreatment factors were balanced between groups except for age (p=0.001). The 10-year actuarial freedom from biochemical failure for all patients treated with PSI was 96.3{\%} with no statistically significant difference between large vs. small/medium prostate size (90{\%} vs. 96.6{\%}, p=0.47). In a multivariate analysis, plan type (hazard ratio [HR]=0.25, p=0.03), dose to 90{\%} of the gland (D90: HR=0.98, p=0.02), volume receiving 200Gy (V200: HR=0.98, p=0.026), and biologic effective dose (HR=0.99, p=0.045), but not prostate size (HR=2.27, p=0.17) were significantly associated with freedom from biochemical failure. Prostate size was not significantly associated with time to maximum American Urologic Association score. Conclusion: In men with large prostates, the PSI provides biochemical control and temporal changes in genitourinary toxicity that are comparable with men having smaller glands. Accurate dose optimization and delivery of PSI provides the best clinical outcomes regardless of gland size.",
author = "Kosj Yamoah and Eldredge-Hindy, {Harriet B.} and Nicholas Zaorsky and Palmer, {Joshua D.} and Doyle, {Laura A.} and Sendecki, {Jocelyn A.} and Hesney, {Adam A.} and Logan Harper and Michael Repka and Showalter, {Timothy N.} and Hurwitz, {Mark D.} and Dicker, {Adam P.} and Den, {Robert B.}",
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Yamoah, K, Eldredge-Hindy, HB, Zaorsky, N, Palmer, JD, Doyle, LA, Sendecki, JA, Hesney, AA, Harper, L, Repka, M, Showalter, TN, Hurwitz, MD, Dicker, AP & Den, RB 2014, 'Large prostate gland size is not a contraindication to low-dose-rate brachytherapy for prostate adenocarcinoma', Brachytherapy, vol. 13, no. 5, pp. 456-464. https://doi.org/10.1016/j.brachy.2014.04.003

Large prostate gland size is not a contraindication to low-dose-rate brachytherapy for prostate adenocarcinoma. / Yamoah, Kosj; Eldredge-Hindy, Harriet B.; Zaorsky, Nicholas; Palmer, Joshua D.; Doyle, Laura A.; Sendecki, Jocelyn A.; Hesney, Adam A.; Harper, Logan; Repka, Michael; Showalter, Timothy N.; Hurwitz, Mark D.; Dicker, Adam P.; Den, Robert B.

In: Brachytherapy, Vol. 13, No. 5, 01.01.2014, p. 456-464.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Large prostate gland size is not a contraindication to low-dose-rate brachytherapy for prostate adenocarcinoma

AU - Yamoah, Kosj

AU - Eldredge-Hindy, Harriet B.

AU - Zaorsky, Nicholas

AU - Palmer, Joshua D.

AU - Doyle, Laura A.

AU - Sendecki, Jocelyn A.

AU - Hesney, Adam A.

AU - Harper, Logan

AU - Repka, Michael

AU - Showalter, Timothy N.

AU - Hurwitz, Mark D.

AU - Dicker, Adam P.

AU - Den, Robert B.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: Prostate volume greater than 50. cc is traditionally a relative contraindication to prostate seed implantation (PSI), but there is little consensus regarding prostate size and clinical outcomes. We report biochemical control and toxicity after low-dose-rate PSI and compare outcomes according to the prostate size. Methods and Materials: A total of 429 men who underwent low-dose-rate PSI between 1998 and 2009 were evaluated. Median followup was 38.7 months. Patients were classified by prostate volume into small, medium, and large subgroups. Differences were analyzed using the Mann-Whitney and Pearson's χ2 tests for continuous and categorical variables, respectively. Cox proportional hazards regression models were used to evaluate effect of prostate size on outcomes. Results: Patient pretreatment factors were balanced between groups except for age (p=0.001). The 10-year actuarial freedom from biochemical failure for all patients treated with PSI was 96.3% with no statistically significant difference between large vs. small/medium prostate size (90% vs. 96.6%, p=0.47). In a multivariate analysis, plan type (hazard ratio [HR]=0.25, p=0.03), dose to 90% of the gland (D90: HR=0.98, p=0.02), volume receiving 200Gy (V200: HR=0.98, p=0.026), and biologic effective dose (HR=0.99, p=0.045), but not prostate size (HR=2.27, p=0.17) were significantly associated with freedom from biochemical failure. Prostate size was not significantly associated with time to maximum American Urologic Association score. Conclusion: In men with large prostates, the PSI provides biochemical control and temporal changes in genitourinary toxicity that are comparable with men having smaller glands. Accurate dose optimization and delivery of PSI provides the best clinical outcomes regardless of gland size.

AB - Purpose: Prostate volume greater than 50. cc is traditionally a relative contraindication to prostate seed implantation (PSI), but there is little consensus regarding prostate size and clinical outcomes. We report biochemical control and toxicity after low-dose-rate PSI and compare outcomes according to the prostate size. Methods and Materials: A total of 429 men who underwent low-dose-rate PSI between 1998 and 2009 were evaluated. Median followup was 38.7 months. Patients were classified by prostate volume into small, medium, and large subgroups. Differences were analyzed using the Mann-Whitney and Pearson's χ2 tests for continuous and categorical variables, respectively. Cox proportional hazards regression models were used to evaluate effect of prostate size on outcomes. Results: Patient pretreatment factors were balanced between groups except for age (p=0.001). The 10-year actuarial freedom from biochemical failure for all patients treated with PSI was 96.3% with no statistically significant difference between large vs. small/medium prostate size (90% vs. 96.6%, p=0.47). In a multivariate analysis, plan type (hazard ratio [HR]=0.25, p=0.03), dose to 90% of the gland (D90: HR=0.98, p=0.02), volume receiving 200Gy (V200: HR=0.98, p=0.026), and biologic effective dose (HR=0.99, p=0.045), but not prostate size (HR=2.27, p=0.17) were significantly associated with freedom from biochemical failure. Prostate size was not significantly associated with time to maximum American Urologic Association score. Conclusion: In men with large prostates, the PSI provides biochemical control and temporal changes in genitourinary toxicity that are comparable with men having smaller glands. Accurate dose optimization and delivery of PSI provides the best clinical outcomes regardless of gland size.

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