eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 16
Original paper

Differential outcomes of re-stratified high-risk prostate cancer patients treated with external beam radiation therapy plus high-dose-rate brachytherapy boost

Damien Carignan
1, 2
Brandon Morales
1, 2, 3
Philippe Després
2, 4, 5
William Foster
1, 3
André-Guy Martin
1, 2, 3
Eric Vigneault
1, 2, 3

  1. Centre de Recherche du CHU de Québec-Université Laval, Axe Oncologie, Québec, Canada
  2. Centre de Recherche sur le Cancer de l’Université Laval, Québec, Canada
  3. CHU de Québec-Université Laval, Service de Radio-Oncologie, Québec, Canada
  4. Faculté des Sciences et de Génie de l’Université Laval, Département de Physique, Génie Physique et Optique, Pavillon Alexandre-Vachon, Québec, Canada
  5. Centre de Recherche de l’Institut Université de Cardiologie Pneumologie de Québec, Québec, Canada
J Contemp Brachytherapy 2024; 16, 2: 103–110
Online publish date: 2024/04/30
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We report outcomes of high-risk prostate cancer (PCa) patients, initially classified according to a 3-tier NCCN classification system, treated with external beam radiation therapy (EBRT) and high-dose-rate brachytherapy boost (HDR-BT). Patients were analyzed based on a re-stratification of their risk grouping using CAPRA score and a newer 5-tier NCCN classification.

Material and methods:
471 high-risk PCa patients treated with EBRT, HDR-BT, and androgen deprivation therapy (ADT) between 1999 and 2018 were included. Competing risk survival analyses to compare individuals with CAPRA scores < 6 vs. ≥ 6 for biochemical relapse (BCR) and metastasis incidence were conducted. Also, overall survival (OS) for both groups using Kaplan-Meier analysis was assessed. The same analyses were repeated using a 5-tier NCCN stratification comparing those classified as high-risk vs. very high-risk patients.

The median age was 71 years, and the median follow-up period was 72 months. The whole cohort received an EQD2 of 74 Gy or greater, with a median EQD2 of 106.89 Gy. Both a CAPRA score ≥ 6 and belonging to the NCCN very high-risk group were associated with BCR, with subdistribution hazard ratios (sHRs) of 3.04 (p = 0.015) and 2.53 (p = 0.013), respectively. For metastasis incidence, both the CAPRA and NCCN groups had similar sHRs of 2.60 (p = 0.094) and 2.71 (p = 0.037), respectively. For 10-year OS, patients with CAPRA score ≥ 6 and belonging to the NCCN very high-risk group presented similar HRs of 2.11 (p = 0.005) and 2.10 (p = 0.002).

We showed that high-risk PCa patients classified according to the 3-tier NCCN system benefit from further stratification using the CAPRA score or the 5-tier NCCN stratification method. Patients with a CAPRA score ≥ 6 or classified as very high-risk demonstrate a higher hazard of BCR, metastasis, and death. These patients might benefit from further intensification of their investigations and treatment, based on ongoing research.


prostate cancer, high-dose-rate brachytherapy, risk stratification

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