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This study assesses how non-prostate cancer deaths impact long-term survival in younger men treated with brachytherapy.

June 4, 2026Open Access

Non-Prostate Cancer Deaths Best Predict Long-Term Survival in Men ≤59 Years of Age Treated with LDR Brachytherapy with or without Supplemental Therapies: A Mandate for Health Enhancement

Key Points

This study assesses how non-prostate cancer deaths impact long-term survival in younger men treated with brachytherapy.
782 men ≤59 years underwent brachytherapy with or without supplemental therapies.
Patients were divided into two age groups: ≤54 and 55-59 years old.
Clinical, pathologic, and treatment parameters were analyzed for their effect on survival.
15-year biochemical failure rate was 4.9%, with prostate cancer-specific mortality at 1.8% and overall mortality at 16.5%.
Non-prostate cancer deaths accounted for 87.7% of all fatalities, primarily due to cardiovascular disease and other malignancies.
Multivariate analysis indicated that overall mortality was significantly associated with age, diabetes, and current tobacco use.

Abstract

AbstractPurpose Despite favorable biochemical and functional outcomes in younger patients treated with prostate brachytherapy, overall survival (OS) remains compromised by a plethora of non-prostate cancer deaths, especially those attributable to sedentary lifestyle or modifiable health risks. In this study, we evaluate cancer control, patterns of death and propose recommendations for lifestyle changes and aggressive management of medical comorbidities. Methods 782 consecutive men ≤59 years of age underwent brachytherapy with or without supplemental therapies. Patients were stratified into 2 age cohorts:≤54 (n=331) and 55-59 (n=451). Post-implant dosimetry was based on day 0 CT evaluation. Biochemical failure (BF) was defined as PSA>0.40 ng/ml after nadir. Patients with metastatic prostate cancer or non-metastatic castrate resistant disease were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, pathologic and treatment parameters were evaluated for impact on survival. Results No significant differences in presentation were discerned between the 2 cohorts except hypertension and tobacco were statistically more common in 55-59. The median follow-up was 12.1 years. 40.8% of patients presented with UIR or HR. The median day 0 D90 was 122.1%. For the entire cohort, 15-year BF, PCSM and OM were 4.9%, 1.8% and 16.5%. When stratified by age,15-year BF was 6.1% and 4.0% in the younger and older cohorts (p= 0.205). 15-year OM was 11.6% and 20.1% in ≤54 and 55-59 (p=0.002). Prostate cancer accounted for 12.3% of all deaths with cardiovascular disease plus other malignancies comprising 61.4%. In MVA, BF was best predicted by high risk (sHR 10.180, p≤0.001) and percent positive biopsies (sHR 1.024, p=0.004), PCSM by percent positive biopsies (sHR 1.030, p=0.024) and OM by age (HR 1.105, p=0.002), diabetes (HR 1.890, p=0.036), and current tobacco (HR 2.989, pConclusions Brachytherapy generates favorable oncologic outcomes in younger men with prostate cancer. Non-prostate 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.

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