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Medical Management of Modifiable Risks: Improving Survival in High-Risk Prostate Cancer Patients Receiving
Shalini Moningi1, Grgur Mirić2, Robert W Galbreath2,3
1Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, 9500 Euclide Avenue, CA-50, Cleveland, OH 44195, USA.
Journal of Clinical Medicine
|July 28, 2026
Summary
High-risk prostate cancer patients treated with brachytherapy (BT) had excellent cancer control but faced high overall mortality, primarily from cardiovascular disease and other cancers, not prostate cancer itself.
Area of Science:
- Oncology
- Radiation Oncology
- Urology
Background:
- High-risk prostate cancer demands aggressive treatment due to progression risk.
- Brachytherapy (BT) with supplemental therapies offers oncologic benefits but has been limited by non-prostate cancer deaths.
- This study analyzes outcomes in high-risk prostate cancer patients treated with BT, focusing on mortality patterns.
Purpose of the Study:
- To report on biochemical failure (BF), prostate cancer-specific mortality (PCSM), and overall mortality (OM) in high-risk prostate cancer patients treated with LDR BT.
- To identify patterns of death and provide recommendations for mitigating non-prostate cancer mortality.
- To evaluate the impact of clinical, pathological, and treatment factors on patient outcomes.
Main Methods:
- Retrospective analysis of 577 consecutive high-risk prostate cancer patients treated with LDR BT (97.9% Pd-103) from April 1995 to November 2018.
- Patients stratified by age; 94.6% received supplemental external beam radiation therapy (EBRT) and 63.3% received androgen deprivation therapy (ADT).
- Biochemical failure defined as PSA > 0.40 ng/mL post-nadir; cause of death determined for all patients; multivariate analysis (MVA) performed.
Main Results:
- Median follow-up was 8.9 years; 87.5% had a single high-risk factor. Fifteen-year BF, PCSM, and OM were 12.4%, 5.6%, and 51.7%, respectively.
- Overall mortality increased linearly for 10 years, then doubled from years 10-15.
- Prostate cancer accounted for 10.9% of deaths, cardiovascular disease for 38.1%, and other malignancies for 28.4%. MVA identified age and tobacco use as predictors of OM.
Conclusions:
- Despite high cancer control rates with BT, overall survival is limited by significant non-prostate cancer mortality, particularly from cardiovascular disease and other malignancies.
- Non-prostate cancer deaths were six times more likely than prostate cancer deaths.
- Implementing a comprehensive multidisciplinary survivorship program is crucial for improving longevity in this patient population.
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