Gleason 9s & 10s do better with brachy boost than with surgery or external beam alone

This will not come as a great surprise to JNF, Michael-T, CaliJr, and other HW members who have gone for the "triple play" of external beam radiation (EBRT) with a brachy boost (BT) and hormone therapy (ADT). But for men newly diagnosed with a GS 9 or 10, this study adds to the evidence that the combination is the preferred alternative.

They looked at very high risk patients who were treated in the modern era at UCLA and Fox Chase. They compared the cancer-control outcomes of consecutive 487 patients treated beginning with surgery, or EBRT+BT or EBRT alone. On all measures: biochemical recurrence, starting lifelong ADT, distant metastases, and prostate-cancer survival, the 'triple play" was much better than the alternatives.

Here's an analysis of the study:

For very high-risk patients, EBRT + BT is superior to surgery or EBRT only

They plan an expanded f/u study that will include data from Memorial Sloan Kettering, Cleveland Clinic, and Harvard.

- Allen

As always, thanks for sharing. (Particularly studies that speak to my confirmation bias.) What's interesting to me is the 84% of RP patients that had biochemical recurrence. Does that mean 84% of RP patients needed SRT? If so that seems awful high to me. I hope that I'm not interpreting that correctly.

OTOH, there was a newly diagnosed G9 that posted in the last few days that said his uro at UCLA said that only 30% of G9 patients needed SRT after surgery. That percentage actually felt a little low to me. This is just my gut reaction to the numbers and not based on any science.

Us great 8's like it too.

Thanks for the information....a confidence booster. Hope more men get the opportunity to learn about the current radiotherapy choices. Very effective.

Michael-T said...
Does that mean 84% of RP patients needed SRT? If so that seems awful high to me.

55% of all RP patients had either adjuvant or salvage radiation. 84% of all RP patients reached a PSA of 0.2ng/ml. But that may have been after surgery, or after adjuvant or salvage radiation. Among those who reached 0.2 ng/ml after surgery and had no detectable metastases, 85% then had salvage radiation.

You can easily understand the high failure rate when you look at post-surgery pathology: 78% were stage pT3/4, 41% had positive margins, and 16% had positive LNs. The lesson here is that GS9&10 are highly invasive, and almost never really contained in the capsule (even when they appear to be on an MRI).

Michael-T said...
OTOH, there was a newly diagnosed G9 that posted in the last few days that said his uro at UCLA said that only 30% of G9 patients needed SRT after surgery. That percentage actually felt a little low to me.

Perhaps what his uro actually said, and maybe the patient misunderstood, was that only 30% of G9 patients needed radiation right after surgery, that is adjuvant radiation. In this study, 39% had adjuvant radiation. That usually means that it was so obvious they missed something that there was no point, and some danger, in waiting for the PSA to go up to 0.2 ng/ml; or that they just planned on doing both from the start. 55% had adjuvant or salvage, but some were undertreated.

- Allen

Thanks, Allen, for posting this important analysis. I look forward to any f/u analysis that reports the toxicities and SE's from EBRT + BT boost, especially since I will probably opt for this treatment protocol at some point.

Hey Dave, good to see you here again! As you know, I was following behind you on the Triple Play path. Glad to know you're doing well--same here!

Dave and Michael

I'm following the same treatment plan. Appreciate reading about your results. Very encouraging to someone struggling along with the ADT (Lupron) side effects.

Al