Can Intermediate-Risk Patients Be Safely Treated With Permanent Implant Prostate Brachytheray: Long-Term Results of the First 1044 Patients of the Paris Institut Curie/Cochin Hospital/Necker Hospital Group

Purpose: To analyze the overall survival and the relapse-free survival in the first 1044 patients treated at Institut Curie. Furthermore, to compare the outcome of low-risk patients meeting the American Brachytherapy Society (ABS) criteria with intermediate-risk patients (non-ABS) in our cohort (32%). Materials and Methods: 1044 patients were treated with exclusive permanent loose 125I seeds implantation between January 1999 and September 2005 at the Paris Institut Curie, Cochin Hospital and Necker Hospital group. Within this cohort, 701 patients (68%) met the ABS criteria and 332 patients were intermediate-risk (32%), of which 170 (16.5%) had a PSA between 10 and 15, 129 (12.5%) had a Gleason score of 7, and 29 (3%) had both. Results: With a median followup of 6.5 years, overall 5-year survival (5-yr OS) and relapse-free survival (5-yr RFS) were 96% and 94%, respectively. When comparing non-ABS to ABS patients, only the 5-yr RFS was significantly lower (97% vs. 87%). Among the non-ABS subgroups, patients with PSA 10-15 and a Gleason score (GS) of 7 had the worst 5-yr RFS (69%). Patients with only PSA 10-15 did better than those with a GS of 7 (92% vs. 87%). Conclusions: Our results suggest that intermediate-risk patients with both PSA 10-15 and GS of 7 should not be offered permanent implant brachytherapy as monotherapy.