title: An eight-year experience of HDR brachytherapy boost for localized prostate cancer: biopsy and PSA outcome.
abstract: OBJECTIVE
  To evaluate the biochemical recurrence-free survival (bRFS), the 2-year biopsy outcome and the prostate-specific antigen (PSA) bounce in patients with localized prostate cancer treated with an inversely planned high-dose-rate (HDR) brachytherapy boost.
  
  
  METHODS
  Data were collected from 153 patients treated between 1999 and 2006 with external beam pelvic radiation followed by an HDR Ir-192 prostate boost. These patients were given a boost of 18 to 20 Gy using inverse-planning with simulated annealing (IPSA).We reviewed and analyzed all prostate-specific antigen levels and control biopsies.
  
  
  RESULTS
  The median follow-up was 44 months (18-95 months). When categorized by risk of progression, 74.5% of patients presented an intermediate risk and 14.4% a high one. Prostate biopsies at 2 years posttreatment were negative in 86 of 94 patients (91.5%), whereas two biopsies were inconclusive. Biochemical control at 60 months was at 96% according to the American Society for Therapeutic Radiology and Oncology and the Phoenix consensus definitions. A PSA bounce (PSA values of 2 ng/mL or more above nadir) was observed in 15 patients of 123 (9.8%). The median time to bounce was 15.2 months (interquartile range, 11.0-17.7) and the median bounce duration 18.7 months (interquartile range, 12.1-29). The estimate of overall survival at 60 months was 97.1% (95% CI, 91.6-103%).
  
  
  CONCLUSIONS
  Considering that inverse planned HDR brachytherapy prostate boosts led to an excellent biochemical response, with a 2-year negative biopsy rate, we recommend a conservative approach in face of a PSA bounce even though it was observed in 10% of patients.
authors.affiliation: Département de Radio-Oncologie, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Centre de Recherche en Cancérologie de l'Université Laval, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Bachand
authors.forename: André-Guy
authors.initials: AG
authors.lastname: Martin
authors.forename: Luc
authors.initials: L
authors.lastname: Beaulieu
authors.forename: François
authors.initials: F
authors.lastname: Harel
authors.forename: Eric
authors.initials: E
authors.lastname: Vigneault
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage
chemical_list: D017430:Prostate-Specific Antigen