Nonprostate Cancer Deaths Best Predict Long-Term Survival in Men Aged ≤59 Years Treated With Low Dose Rate Brachytherapy With or Without Supplemental Therapies: A Mandate for Health Enhancement.

Authors

Peter Orio, Grgur Mirić, Robert Galbreath, Shalini Moningi, Ryan Fiano, Kent Wallner, Martin King

Published in

Advances in radiation oncology. Volume 11. Issue 10. Pages 102101. Epub Jun 01, 2026.

Abstract

Despite favorable biochemical and functional outcomes in younger patients treated with prostate brachytherapy, overall survival remains compromised by a plethora of nonprostate cancer deaths, especially those attributable to sedentary lifestyle or modifiable health risks. In this study, we evaluate cancer control and patterns of death and propose recommendations for lifestyle changes and aggressive management of medical comorbidities.
A total of 782 consecutive men aged ≤59 years underwent brachytherapy with or without supplemental therapies. Patients were stratified into 2 age cohorts: ≤54 years (n = 331) and 55 to 59 years (n = 451). Postimplant dosimetry was based on the day 0 computed tomography evaluation. Biochemical failure (BF) was defined as prostate-specific-antigen (PSA) > 0.40 ng/mL after nadir. Patients with metastatic prostate cancer or nonmetastatic castrate-resistant disease who died of any cause were classified as deaths from prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, pathologic, and treatment parameters were evaluated for their impact on survival.
No significant differences in presentation were observed between the 2 cohorts, except that hypertension and tobacco use were statistically more common in the 55- to 59-year-old age group. The median follow-up was 12.1 years. A total of 40.8% of patients presented with unfavorable intermediate- or high-risk disease. The median day 0 minimum dose of radiation to 90% of the prostate gland (D90) was 122.1%. For the entire cohort, the 15-year BF, prostate cancer-specific mortality, and overall mortality (OM) rates were 4.9%, 1.8%, and 16.5%, respectively. When stratified by age, the 15-year BF rates were 6.1% and 4.0% in the younger and older cohorts, respectively (p = .205). The 15-year OM rates were 11.6% and 20.1% in the ≤54- and 55- to 59-year-old groups, respectively (p = .002). Prostate cancer accounted for 12.3% of all deaths, with cardiovascular disease and other malignancies comprising 61.4%. In multivariate analysis (MVA), BF was best predicted by high risk (subdistribution hazard ratio [sHR], 10.180; p ≤ .001) and percent positive biopsies (sHR, 1.024; p = .004), prostate cancer-specific mortality by percent positive biopsies (sHR, 1.030; p = .024), and OM by age (hazard ratio [HR], 1.105; p = .002), diabetes (HR, 1.890; p = .036), and current tobacco use (HR, 2.989; p < .001).
Brachytherapy generates favorable oncologic outcomes in younger men with prostate cancer. Nonprostate cancer deaths substantially outnumber prostate cancer deaths, with the majority due to cardiovascular disease or other malignancies. Improvement in overall survival will require multiple lifestyle changes and aggressive management of modifiable health risks.

PMID:
42438566
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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