RATIONALE: Androgens can cause the growth of prostate cancer cells. Antihormone therapy,
such as leuprolide and bicalutamide, may lessen the amount of androgens made by the body.
Implant radiation therapy kills tumor cells by placing material such as radioactive iodine
directly into or near a tumor. Giving leuprolide and bicalutamide together with implant
radiation therapy may kill more tumor cells.
PURPOSE: This phase II trial is studying the side effects of giving leuprolide and
bicalutamide together with implant radiation therapy and to see how well it works in
treating patients with locally recurrent prostate cancer after external-beam radiation
- Determine the feasibility and patient tolerance of interstitial brachytherapy combined
with androgen-deprivation therapy for patients with locally recurrent prostate cancer
after prior external-beam irradiation.
- Determine the toxicity of interstitial brachytherapy combined with androgen-deprivation
therapy in these patients.
- Determine the tumor response to interstitial brachytherapy combined with
androgen-deprivation therapy in these patients.
OUTLINE: Patients receive neoadjuvant therapy comprising leuprolide acetate intramuscularly
for 3 months and oral bicalutamide once daily for 30 days, beginning on the first day of
leuprolide acetate administration. Patients then undergo interstitial brachytherapy
implantation with I-125. Following brachytherapy, patients receive adjuvant leuprolide
acetate every 3 months for an additional 6 months.
Quality of life is assessed at baseline and at every treatment and follow-up visit.
After completion of study therapy, patients are followed every 3 months for 2 years, every
to 4-6 months for 3 years, and then annually thereafter.
- Biopsy-proven adenocarcinoma of the prostate
- Locally recurrent disease, defined by digital rectal examination and/or rising
prostate-specific antigen (PSA)
- No evidence of nodal or distant metastasis (i.e., N0, M0) on physical examination,
bone scan, or CT scan of the pelvis
- Clinical stage T1c-T3a disease at the time of recurrence
- PSA < 10 ng/mL
- Prostate volume by transrectal ultrasonography < 60 cc
- Received prior external beam radiotherapy
- ECOG performance status 0-2
- WBC ≥ 3,000/μL
- Platelet count ≥ 90,000/μL
- Hemoglobin ≥ 10 g/dL
- Alkaline phosphatase < 2 times normal
- AST < 2 times normal
- Normal prothrombin time and partial thromboplastin time
- No significant obstructive urinary symptoms (AUA score ≤ 16)
- No contraindication for general anesthesia
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior transurethral resection of the prostate