title: Permanent prostate brachytherapy: pathologic implications as assessed on radical prostatectomy specimens of broadening selection criteria for monotherapy.
abstract: OBJECTIVE
  To assess the impact of clinical selection criteria on pathologic features among patients treated by radical retropubic prostatectomy and to evaluate the implications of broadening eligibility for permanent prostate brachytherapy monotherapy.
  
  
  METHODS
  A consecutive series of 423 patients with prostate cancer, who underwent diagnostic biopsy and subsequent radical retropubic prostatectomy, were selected for this study. Four subgroups were defined using the American Brachytherapy Society selection criteria, including prostate size limits (group 1), no prostate size limits (group 2A), a modified set of criteria (group 2B), and clinical Stage T1-T2 (group 3). The rates of extraprostatic extension, seminal vesicle invasion, and lymph node involvement were compared.
  
  
  RESULTS
  Adverse pathologic features at radical retropubic prostatectomy were noted in 8 (9.3%) of 86 patients in group 1, 11 (5.6%) of 195 patients in group 2A, 35 (12.0%) of 292 patients in group 2B, and 90 (21.8%) of 413 patients in group 3. The rates of extraprostatic extension, seminal vesicle invasion, and lymph node involvement appeared comparable among groups 1 (5.8%, 3.5%, and 0.0%, respectively), 2A (3.6%, 2.1%, and 0.0%, respectively), and 2B (6.9%, 3.8%, and 1.4%, respectively), but were greater in group 3 (9.7%, 7.8%, and 4.4%, respectively).
  
  
  CONCLUSIONS
  Judicious broadening of the clinical selection criteria may allow a greater number of patients to be eligible for permanent prostate brachytherapy monotherapy by including patients whose risk of having adverse pathologic features is comparable to that of patients currently deemed suitable for permanent prostate brachytherapy monotherapy. Prospective assessment of oncologic outcomes of such an approach is required.
authors.affiliation: Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
authors.forename: Shomik
authors.initials: S
authors.lastname: Sengupta
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.forename: Lance A
authors.initials: LA
authors.lastname: Mynderse
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sebo
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.forename: David W
authors.initials: DW
authors.lastname: Hillman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: Torrence M
authors.initials: TM
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery