title: Favorable clinical outcomes of three-dimensional computer-optimized high-dose-rate prostate brachytherapy in the management of localized prostate cancer.
abstract: OBJECTIVE
  To report PSA relapse-free survival and toxicity outcomes of prostate cancer patients who have undergone three-dimensional computer-optimized high-dose-rate (HDR) brachytherapy with external beam radiotherapy as definitive treatment.
  
  
  METHODS
  One hundred five patients consecutively treated between 1998 and 2004 are reported. All patients were treated with HDR boost with lr 192 (5.5-7.0 Gy), based upon postimplant CT three-dimensional treatment planning using an in-house treatment plan optimization algorithm. Three-dimensional conformal external beam radiotherapy (45-50.4 Gy) was also administered 3 weeks after the HDR procedure. Toxicity was measured using National Cancer Institutes Common Toxicity Criteria and International Prostate Symptom Score indices.
  
  
  RESULTS
  With a median followup of 44 months (8-79 months), the 5-year PSA relapse-free survival outcomes for low, intermediate and high-risk patients were 100%, 98%, and 92%, respectively, Median urinary toxicity, and 93% of patients denied rectal problems at the time of last followup. Erectile dysfunction was noted in 47% patients at the time of last followup, but overall 80% were able to achieve vaginal penetration when those who responded to sildenafil were included.
  
  
  CONCLUSIONS
  Computer-optimized three-dimensional HDR prostate brachytherapy provides excellent disease control for even high risk localized prostate cancer. Significant toxicity has been minimal.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. yamadaj@mskcc.org
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.forename: Sudershan
authors.initials: S
authors.lastname: Bhatia
authors.forename: Marco
authors.initials: M
authors.lastname: Zaider
authors.forename: Gilad
authors.initials: G
authors.lastname: Cohen
authors.forename: Machele
authors.initials: M
authors.lastname: Donat
authors.forename: James
authors.initials: J
authors.lastname: Eastham
authors.forename: Farhang
authors.initials: F
authors.lastname: Rabbani
authors.forename: Karen
authors.initials: K
authors.lastname: Schupak
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.forename: Boris
authors.initials: B
authors.lastname: Mueller
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
mesh_terms: D000328:Adult; D000368:Aged; D004307:Dose-Response Relationship, Radiation; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome