Neoadjuvant Hormonal Therapy Plus Brachytherapy Vs. Brachytherapy Alone For Patients With Prostate Cancer: A Single Institution Retrospective Study.

4674 Background: Neoadjuvant hormonal therapy(NHT) has sometimes been used in patients with prostate cancer opting for brachytherapy. We compared the biochemical response to NHT plus prostate brachytherapy(PBT) versus PBT alone in a consecutive series of patients treated at our institution. Methods: From 1996–2000, 125 consecutive patients with adenocarcinoma of the prostate with clinical stage T1c-T2a,b; Gleason score (GS) 3–8; PSA of 1.1 - 30 were treated either with NHT plus I-125 seed implants (Group1; n=36) vs. seed implant alone (Group2; n=89). None of these patients recieved external beam radiation. The indications for hormone therapy were most often intermediate risk disease (GS 7–8 or PSA 10–30) or significant prostatic enlargement. Prescribed radiation dose was 16,000 cGy to the periphery of the prostate. NHT was a 3 or 4 month leuprolide injection before PBT. Patients were evaluated for biochemical recurrence according to the ASTRO consensus statement, and for achieving and maintaining a PSA nadir ≤1.0, ≤0.5 or ≤0.2. The mean follow up was 43 months (Group1= 43 vs. Group2= 44), with a range of 24–80 months. Results: please see the summary in table below. Conclusions: There was no significant difference appreciated in biochemical failure rate or PSA nadir between NHT plus seed implant vs. seed implant alone. The only significant difference noted between the groups was the mean initial PSA being higher in the group who received NHT. A beneficial effect of NHT in reducing the volume of disease and improving the prognosis is possible. No significant financial relationships to disclose.