title: Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation.
abstract: OBJECTIVE
  To assess long-term prostate-specific antigen (PSA) outcome after permanent prostate brachytherapy (BT) and identify predictors of improved disease-free survival.
  
  
  METHODS
  Eleven institutions combined data on 2,693 patients treated with permanent interstitial BT monotherapy for T1-T2 prostate cancer. Of these patients, 1,831 (68%) were treated with I-125 (median dose, 144 Gy) and 862 (32%) were treated with Pd-103 (median dose, 130 Gy). Criteria for inclusion were: available pre-BT PSA, BT > or =5 years before data submission, BT between 1988-1998, and no androgen deprivation before failure. The median follow-up was 63 months.
  
  
  RESULTS
  Among patients where the I-125 dose to 90% of the prostate (D90) was > or =130 Gy, the 8-year PSA relapse-free survival (PRFS) was 93% compared with 76% for those with lower D90 dose levels (p < 0.001). A multivariable analysis identified tumor stage (p = 0.002), Gleason score (p < 0.001), pretreatment PSA level (p < 0.001), treatment year (p = 0.001), and the isotope used (p = 0.004) as pretreatment and treatment variables associated with PRFS. When restricted to patients with available postimplantation dosimetric information, D90 emerged as a significant predictor of biochemical outcome (p = 0.01), and isotope was not significant. The 8-year PRFS was 92%, 86%, 79%, and 67%, respectively, for patients with PSA nadir values of 0-0.49, 0.5-0.99, 1.0-1.99, and >2.0 ng/mL (p < 0.001). Among patients free of biochemical relapse at 8 years, the median nadir level was 0.1 ng/mL, and 90% of these patients achieved a nadir PSA level <0.6 ng/mL.
  
  
  CONCLUSIONS
  Outcome after permanent BT for prostatic cancer relates to tumor stage, Gleason score, pretreatment PSA, BT year, and post-BT dosimetric quality. PSA nadir < or =0.5 ng/mL was particularly associated with durable long-term PSA disease-free survival. The only controllable factor to impact on long-term outcome was the D90 which is a reflection of implant quality.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. zelefskm@mskcc.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.forename: Larry B
authors.initials: LB
authors.lastname: Levy
authors.forename: Louis
authors.initials: L
authors.lastname: Potters
authors.forename: David C
authors.initials: DC
authors.lastname: Beyer
authors.forename: John C
authors.initials: JC
authors.lastname: Blasko
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Zietman
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Pisansky
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elshaikh
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horwitz
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D010165:Palladium / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen