Author/Authors :
Steven J. Frank، نويسنده , , Peter D. Grimm، نويسنده , , John E. Sylvester، نويسنده , , Gregory S. Merrick، نويسنده , , Brian J. Davis، نويسنده , , Anthony Zietman، نويسنده , , Brian J. Moran، نويسنده , , David C. Beyer، نويسنده , , Mack Roach III، نويسنده , , Daniel H. Clarke، نويسنده , , Richard G. Stock، نويسنده , , W. Robert Lee، نويسنده , , Jeff M. Michalski، نويسنده , , Kent E. Wallner، نويسنده , , Mark Hurwitz، نويسنده , , Louis Potters، نويسنده , , Deborah A. Kuban، نويسنده , , Bradley R. Prestidge، نويسنده , , Robyn Vera، نويسنده , , Shannon Hathaway، نويسنده , , et al.، نويسنده ,
Abstract :
Purpose
This study is aimed at understanding and defining the current patterns of care with respect to prostate brachytherapy for patients with intermediate-risk localized disease in the combined academic and community setting.
Methods and materials
A nomogram-based survey was developed at the Seattle Prostate Institute defining the accepted criteria for intermediate-risk prostate cancer. Patients were defined as having intermediate-risk prostate cancer if they met one of the following criteria: prostate-specific antigen (PSA) >10 ng/dL, Gleason score (GS) ≥7, or cT2b or cT2c disease. Additional potential predictive factors including perineural invasion (PNI), GS 3 + 4 vs. 4 + 3, and high-volume disease were included.
Results
In the absence of PNI, all of those surveyed would perform monotherapy for intermediate-risk patients, GS 7 (3 + 4) or PSA 10–20, with cT1c and <30% cores +. Up to 80% would perform monotherapy for patients with cT1c, GS 7 (4 + 3), and <30% cores +. Eighty to 90% of physicians would perform an implant alone with cT2a and either a PSA of 10–20 or GS of 7 (3 + 4) and <30% cores +. Fifty to 60% of those surveyed stated that they would treat a patient with cT2b disease, GS 7 (3 + 4), or PSA 11–20, with less than two-thirds of the biopsy cores positive in the absence of PNI.
Conclusions
This Patterns of Care (POC) study reveals that certain subsets of intermediate-risk localized prostate cancer patients are considered appropriate candidates for an interstitial implant alone.