title: Actuarial disease-free survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of interactive transperineal brachytherapy under biplane ultrasound and fluoroscopic guidance in patients with localized prostate cancer.
  
  
  METHODS
  Brachytherapy using 125I or 103Pd radioactive seeds either alone or in combination with adjunctive external beam radiotherapy (XRT) was administered to 490 patients at a single institution. Post-treatment follow-up included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels and documentation of treatment-related symptoms and complications.
  
  
  RESULTS
  Actuarial disease-free survival at 5 yr was 79% (95% CI, 71-85%), and the 5-yr actuarial rate of local control was 98% (95% CI, 94-99%). Post-treatment PSA nadir and pretreatment PSA level were found to be significant predictors of disease-free survival. In patients with a PSA nadir < 0.5 ng/ml, 5-yr disease-free survival was 93% (95% CI, 84-97%), compared with 25% (95% CI, 5-53%) in patients whose PSA nadir was 0.5-1.0 ng/ml and 15% (95% CI, 3-38) in patients with a PSA nadir > 1.0 ng/ml. Brachytherapy was well tolerated with few post-treatment complications.
  
  
  CONCLUSIONS
  A broad range of patients with localized prostate cancer can benefit from transperineal brachytherapy with minimal morbidity. A post-treatment PSA nadir below 0.5 ng/ml provides a useful prognostic indicator of favorable long-term outcome.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Grado
authors.forename: T R
authors.initials: TR
authors.lastname: Larson
authors.forename: C S
authors.initials: CS
authors.lastname: Balch
authors.forename: M M
authors.initials: MM
authors.lastname: Grado
authors.forename: J M
authors.initials: JM
authors.lastname: Collins
authors.forename: J S
authors.initials: JS
authors.lastname: Kriegshauser
authors.forename: G P
authors.initials: GP
authors.lastname: Swanson
authors.forename: R J
authors.initials: RJ
authors.lastname: Navickis
authors.forename: M M
authors.initials: MM
authors.lastname: Wilkes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001918:Brachytherapy; D018572:Disease-Free Survival; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D017211:Treatment Failure; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen