Genitourinary Cancer

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SU_30_2306 - Long Term Results of Cs-131 Monotherapy as Definitive Therapy in a Prospectively-Followed Group of Low Risk Localized Prostate Cancer Patients

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Long Term Results of Cs-131 Monotherapy as Definitive Therapy in a Prospectively-Followed Group of Low Risk Localized Prostate Cancer Patients
B. J. Moran Jr, and M. H. Braccioforte; Prostate Cancer Foundation of Chicago, Westmont, IL

Purpose/Objective(s): Cesium-131 has been available as a permanently implantable brachytherapy source since 2005. Published long-term biochemical control rates for the earlier available Iodine-125 and Palladium-103 sources in the treatment of localized prostate cancer have been available prior to the introduction of Cesium-131. As a result, some question remains as to the long-term performance of Cesium-131 in establishing biochemical control in the localized prostate cancer patient relative to the other two radio-isotopes.

Materials/Methods: A large prospective database maintained since 2000 was queried for low risk prostate cancer patients treated with Cesium-131 monotherapy prior to 2010 and for whom PSA follow-up data was available. “Low risk” was defined per NCCN guidelines as Gleason 3+3 or less disease at diagnostic biopsy, diagnostic serum PSA <= 10 ng/ml and clinical stage T2a or less.

Results: A total of 261 patients were available for analysis per the query criteria. Mean/median diagnostic PSA were 5.6 / 5.4 ng/ml, respectively. 99% of patients were graded as Gleason 3+3, and clinical stage was T1c in 91%. Median follow-up for the group was 66.9 months. A total of 2,847 follow-up PSA measurements were analyzed for the group, an average of 10.9 per patient. Eighteen (18) patients (7%) underwent three months of hormonal therapy prior to implant for the purpose of gland downsizing. The Phoenix definition was used to score each patient as a failure or censored observation. Failure time was determined at call and no further follow-up data was considered for failed patients. Patients who exhibited no rises or exhibited a “bounce” (a rise above nadir where subsequent PSA profile showed a downward trend) were censored at last follow-up. 10 patients (3.8%) were scored as failures. Kaplan-Meier functions returned BRFS rates of 97% at 5 years (155 at risk); 94% at 8 years (75 at risk); 93% at 9 years (47 at risk), and 90% at 10 years (19 at risk).

Conclusion: This analysis represents the longest followed series of Cesium-131 patients reported to-date. The closely followed and mature nature of this large prospective group of uniformly low risk patients provides strong evidence for the efficacy of Cesium-131 monotherapy in this setting per biochemical endpoint analysis.

Author Disclosure: B.J. Moran: None. M.H. Braccioforte: None.

Brian Moran, MD

Chicago Prostate Cancer Center

Biography:
Brian J. Moran, MD is Medical Director of Chicago Prostate Center, which he helped found in 1997. He has been performing prostate seed implants since 1994.

Dr. Moran is a graduate of Loyola Stritch School of Medicine, where he also completed his residency. He is board-certified by the American Board of Radiology.

An experienced practitioner of prostate brachytherapy, Dr. Moran has performed thousands of prostate seed implants and has proctored physicians all over the United States and the world including Korea, Europe and Hong Kong.

Dr. Moran is a member of multiple specialty societies including the American Society of Therapeutic Radiology and Oncology, the American College of Radiology and the American Brachytherapy Society. His emphasis has been on quality of life issues and long-term outcomes for prostate cancer patients. Dr. Moran is a frequent speaker at professional meetings, and has authored numerous publications in medical journals and textbooks.

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