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Patient treatment analysis of prostate brachytherapy
Prostate cancer is diagnosed in approximately 200,000 men in the United States every year. Despite high cure rates with early detection and treatment, it causes an estimated 28,000 deaths per year.

Numerous approaches are available for the treatment of prostate cancer, none of which has been universally adopted as being ideal for any one particular patient. Included among these options are surgery, radiation therapy, hormonal therapy and active surveillance or observation. Within the radiation therapy choices, external beam radiation therapy and prostate seed brachytherapy (prostate seed implantation) are the most widely available and implemented therapies in the United States.

St. Luke's Hospital was an early adopter of prostate seed brachytherapy implantation (PSBI), spearheaded largely through the efforts of Dr. Anthony Fathman (now retired) and Dr. David Butler. The first prostate seed implants in the greater St. Louis area were performed at St. Luke's Hospital. To this day, we maintain one of the largest PSBI experiences in the country, with over 2,000 cases performed since 1996.

As part of the Oncology Peer Review Process, a study reviewed the results and outcomes of prostate seed implantation performed at St. Luke's Hospital. The year chosen to be reviewed was 2002. During that year, a total of 238 patients were diagnosed with prostate cancer at St. Luke's; 125 of those patients received prostate seed implants. The outcome year for status of the patients at time of last follow-up was 2008.

The patient mix was analyzed according to age, PSA values, and Gleason Scores. Patients were treated with PSBI alone, PSBI in combination with external beam radiation therapy and hormonal therapy + seed implantation +/- external beam radiation therapy.

Of the 125 patients who underwent PSBI, 81 of the 125 patients (65%) were treated with PSBI alone. The other 44 patients (35%) were treated with a combination of PSBI and external beam radiation therapy.

Age Breakdown:
Age 40-49: 1 patient (<1%)
Age 50-59: 11 patients (9%)
Age 60-69: 34 patients (27%)
Age 70-79: 75 patients (60%)
Age 80-89: 4 patients (3%)

PSA Values:
<4 5 patients (5%)
4-10 100 patients (80%)
>10 17 patients (13%)
Unknown 3 patients (2%)

Gleason Score:
Gleason </=6 74 patients (58%)
Gleason 7 39 patients (31%)
Gleason >/=8 12 patients (10%)
Unknown 0 patients (0%)

The disease status of the 125 patients treated with prostate seed brachytherapy was evaluated at the time of last follow-up. Patients with no evidence for disease numbered 114 out of 125, totaling 91 percent of the patients evaluated. Of the 114 patients with no evidence for cancer, nine patients had expired of causes other than cancer. At the time of last follow-up, only three patients (three percent) had evidence for persistent prostate cancer, none of whom had expired of their disease. Eight patients (six percent) had an unknown disease status at the time of last follow-up, five of whom were alive and three of whom had expired. The five-year survival rate of the patients evaluated was 90 percent. A total of 12 patients expired during the time period in question, nine of whom had no evidence for disease at the time of death. The remaining three patients had an unknown disease status at the time of death.

The National Cancer Database was accessed for comparison of St. Luke's Hospital prostate cancer patients to those of other hospital facilities in Missouri diagnosed from 2000 to 2007. The comparison demonstrated that the prostate cancer patient mix was similar to that of patients at other Missouri hospitals with respect to stage, age, Gleason Score and PSA values. The major difference between St. Luke's Hospital and other Missouri hospital prostate cancer patients was in the form of initial therapy utilized. External beam radiation therapy was utilized in 3.76 percent of the patients at St. Luke's Hospital during that period of time, versus 17.86 percent of the patients at other Missouri institutions. Brachytherapy was administered in 43.75 percent of the patients at St. Luke's, and in 20.37 percent of the patients at other Missouri hospitals. A similar difference was noted when St. Luke's was compared to all hospitals in the United States: 3.76 percent versus 23.71 percent for external beam radiation, and 43.75 percent versus 13.58 percent for PSBI.

The results demonstrate that St. Luke's Hospital utilized PSBI as a primary therapy for prostate cancer to a greater degree than other institutions in Missouri or across the United States, as would be expected in a facility with the expertise and ability to provide this treatment option to suitable patients diagnosed with prostate cancer. In addition, the outcomes for prostate cancer patients treated with PSBI at St. Luke's Hospital are better than, or equal to, the national averages achieved at comparable institutions in the United States. This has been achieved through a dedicated team of medical professionals whose aim is to provide consistently superior outcomes in the treatment of prostate cancer with radiation therapy.

St. Luke's has been a strong advocate of this minimally invasive approach in the treatment of prostate cancer. Through early adoption and application of the latest technologies available, the hospital continues to strive to provide the most current and effective treatment choices available to their cancer patients. The Oncology Peer Review Committee will continue to monitor treatment results of cancer patients at St. Luke's Hospital, including an ongoing review of the da Vinci robotic radical prostatectomy approach, in an effort optimize outcomes of oncology patients at St. Luke's Hospital.

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