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Patterns of Death Following Permanent Prostate Brachytherapy

U. rologic. Research Institute. Patterns of Death Following Permanent Prostate Brachytherapy. Gregory S. Merrick, MD Robert Galbreath, PhD Wayne Butler, PhD Kent Wallner, MD Zachariah Allen, MS Sarah Brammer, BS Nathan Bittner, MD. Purpose.

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Patterns of Death Following Permanent Prostate Brachytherapy

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  1. U rologic Research Institute Patterns of Death Following Permanent Prostate Brachytherapy Gregory S. Merrick, MD Robert Galbreath, PhD Wayne Butler, PhD Kent Wallner, MD Zachariah Allen, MS Sarah Brammer, BS Nathan Bittner, MD

  2. Purpose • To evaluate patterns of death including prostate cancer, cardiovascular and second malignancy (non-prostate cancer) mortality in patients undergoing permanent prostate brachytherapy with or without supplemental therapies

  3. Materials and Methods • April 1995 – November 2004 • 1354 consecutive patients • Treated with permanent prostate brachytherapy for stage T1b-T3a (2002 AJCC) prostate cancer • All patients underwent brachytherapy > 3 years prior to analysis

  4. Results • 11 year cause-specific survival was 97% for entire cohort • LR – 99.7% • IR – 99.0% • HR – 90.1% • Overall survival was 74.8% for entire cohort • LR – 82.5% • IR – 78.3% • HR – 61.9%

  5. 100 80 Cause - Specific, 97.0% BPFS, 95.9% 60 Overall, 74.8% Survival (%) 40 20 0 0 2 4 6 8 10 12 Years Since Implant Kaplan-Meier survival curves

  6. Results • Death rate from second malignancies (non-prostate cancer) = 7.2% • No substantial difference when stratified by risk group • Death rate for all other causes = 6.5% for entire cohort • LR – 1.3% • IR – 5.0% • HR – 10.8%

  7. Cause of death, stratified by risk group

  8. 12 Diseases of the Heart, 11.5% 10 8 Other, 7.4% Non - prostate cancer, 7.2% Cumulative Hazard (%) 6 4 Prostate cancer, 3.0% 2 0 0 2 5 8 10 12 Years Since Implant Cumulative hazard of death by select causes

  9. Multivariate analysis via Cox Regression of deaths by disease

  10. Multivariate analysis via Cox Regression of deaths by disease

  11. Conclusion • Death from CaP represented approximately 10% of all deaths with cardiovascular mortality predominating • Overall survival was poorest in the HR group • High risk patients most likely to die from CaP, but divergence in overall survival between HR and LR was due to excess of cardiovascular deaths

  12. Recommendations • Changes in lifestyle to improve cardiovascular health, including cessation of all tobacco products and minimization of ADT use, may improve overall survival in patients with clinically localized prostate cancer.

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