title: Distant and local recurrence in patients with biochemical failure after prostate brachytherapy.
abstract: OBJECTIVE
  To analyze the patterns of failure after the brachytherapy management of localized prostate cancer.
  
  
  METHODS
  From 1990 to 2008, 2869 patients underwent prostate brachytherapy and 213 experienced a prostate-specific antigen (PSA) failure by the Phoenix definition. Of these 213 patients, 33.5% were low, 18.5% intermediate, and 58% high risk.
  
  
  RESULTS
  Of the 119 patients biopsied, 36 (30%) had a least one positive posttreatment biopsy. In univariate and multivariate analyses, PSA doubling time was the most predictive of a positive biopsy. Patients with doubling times < or =3, >3-6, > or =6-10, and >10 months had positive biopsy rates of 9%, 18%, 36%, and 42%, respectively (p=0.01). The actuarial rate of remaining free from distant metastases at 10 years was 73%. Patients with PSA doubling times of < or =3, >3-6, >6-10, and >10 months had freedom from distant metastases rates of 0%, 74%, 78%, and 94.5% at 10 years, respectively (p<0.0001). In multivariate analysis, PSA doubling time and time to PSA failure were the most significant predictors of developing distant metastases.
  
  
  CONCLUSIONS
  About one third of patients harbor a component of local failure and one fourth demonstrate clinical metastases. PSA doubling time can be used to help predict the source of a rising PSA.
authors.affiliation: Department of Radiation Oncology, Mount Sinai School of Medicine, 1184 5th Avenue, New York, NY 10025, USA. richard.stock@mountsinai.org
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stock
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Cesaretti
authors.forename: Pamela
authors.initials: P
authors.lastname: Unger
authors.forename: Nelson N
authors.initials: NN
authors.lastname: Stone
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D000726:Androgen Antagonists / Q000627:therapeutic use; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; D011868:Radioisotopes; D017430:Prostate-Specific Antigen