Biochemical control and toxicity for favorable- and intermediate-risk patients using real-time intraoperative inverse optimization prostate seed implant: Less is more!

PURPOSE: To report the biochemical control rate and clinical outcomes with real-time inverse planning (inverse optimization prostate seed implant [IO-PSI]) for favorable-risk (FR) and intermediate-risk (IR) prostate adenocarcinoma in a community practice setting. This analysis is an extended followup of our initial report, with favorable early biochemical control rate (biochemical nonevidence of disease) of 97% at 4 years. METHODS AND MATERIALS: Three hundred fifty-seven evaluable patients with FR and IR prostate cancer underwent real-time IO-PSI (iodine-125/145 Gy or palladium-103/120 Gy) between 2001 and 2013. RESULTS: With a median followup of 54 months (range, 24-110 months), the absolute biochemical failure free survival of disease was 96%. The 8-year actuarial probability of prostate-specific antigen failure-free survival for FR and IR cohorts was 92.4% and 87%, respectively. Late genitourinary and gastrointestinal toxicity remained low. Late Grade 2 and Grade 3 genitourinary toxicity was 19% and 1%, respectively. Late Grade 2 and 3 rectal bleeding rates were 1% and 0%, respectively. No difference in biochemical control was observed with preimplant short course androgen deprivation or between Gleason score 3 + 4 vs. 4 + 3 patients. No dosimetric parameter was predictive of biochemical failure. Patients with FR had a significantly decreased risk of failure (hazard ratio = 0.26; 95% confidence interval = 0.09-0.78; p = 0.02) compared with those with IR. Patients with a prostate-specific antigen nadir >0.4 ng/mL had an increased risk of failure (hazard ratio = 1.37; 95% confidence interval = 1.27-1.47; p < 0.0001). CONCLUSIONS: Our initial biochemical and clinical outcomes using real-time IO-PSI persisted with extended followup and support our original hypothesis for use of a reduced number of sources, needles, and total activity, suggesting that with IO, less is more.

Antiphospholipid antibodies in chronic hypertension: the value of screening during pregnancy.

To determine if screening for antiphospholipid antibodies in gravid chronic hypertension patients is warranted, we performed a retrospective cohort study to test the association between antiphospholipid antibodies and perinatal outcome in this group of women. The primary outcome we compared was adverse perinatal outcome, defined as delivery <37 weeks' gestation secondary to maternal or fetal indications, intrauterine or neonatal death, birth weight <10th percentile for gestational age, early-onset severe preeclampsia, or placental abruption. Our sample size allowed for the detection of a 60% reduction in the relative risk of adverse perinatal outcome in patients who were antiphospholipid antibody screen negative (80% power, P = 0.05). No increased risk of adverse perinatal outcome was demonstrated among patients with positive serum antiphospholipid antibodies (33.3%, 5/15) versus patients with negative screening (40.0%, 22/55) in our cohort (RR 0.88, 95% Cl 0.38-1.83). Furthermore, antiphospholipid antibody status was not associated with adverse perinatal outcome after controlling for classic indications for antibody screening (RRMH 0.63, 95% Cl 0.30-1.33). In conclusion, chronic hypertension patients with positive antiphospholipid antibody screening are not at increased risk for adverse perinatal outcome compared to those with negative screening. Therefore, screening for antiphospholipid antibodies in chronic hypertension patients without classic indications for screening is not warranted.