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| Patients were characterized as having favorable risk disease if their pretreatment PSA level was 10.0 ng/mL and Gleason score 6; those with one and two adverse prognostic features (PSA > 10 ng/mL and Gleason score >6) were classified as having intermediate and unfavorable risk disease, respectively. from Zelesky. IJROBP 2000;47:1261 |
| Source | Favorable | Intermediate | Unfavorable |
| Stock | 88% | 60% | na |
| D'Amico | 85% | 33% | 5% |
| Potters | 92% | 74% | 55% |
| Zelesky | 88% | 77% | 38% |
| Blasko | 94% | 87% | 65% |
| A recent study form the U of Maryland found similar results for seeds only by risk group The risk groups were favorable (Stage T1-2a, pretreatment PSA up to 10.0 ng/mL, and Gleason score up to 6), intermediate (one of the favorable indicators with a greater value), and unfavorable 2 or more of the favorable indicators with a greater value).The 5-year actuarial PRFS rate for the favorable, intermediate, and unfavorable risk groups was 85%, 63%, and 24%, respectively (see graph) The 5-year actuarial overall survival rate for the favorable, intermediate, and unfavorable risk groups was 90%, 79%, and 85%, respectively. So in other words, at 5 years a patient with a PSA of greater than 10 and a Gleason 7 will still be alive (85% survival) but a seed implant alone the odds that he has been cured (i.e. a PSA less than 1 and stable) was only 24%. So these high risk patients need more than an implant alone (i.e. external beam +/- Leupron) along with the implant |
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| In summary men with a risk factor (PSA over 10 or Gleaon higher than 6) may not do well with a seed implant alone and should probably get combination therapy (e.g. external beam irradiation plus seeds or hormonal therapy then seeds) |
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