title: Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost.
abstract: OBJECTIVE
  Permanent prostate implant brachytherapy (PPI), three-dimensional conformal radiotherapy (3D-CRT), and conformal proton beam radiotherapy (CPBRT) are used in the treatment of localized prostate cancer, although no head-to-head trials have compared these modalities. We studied the biochemical control (biochemical no evidence of disease [bNED]) and prostate-specific antigen (PSA) nadir achieved with contemporary PPI, and evaluated it against 3D-CRT and CPBRT.
  
  
  METHODS
  A total of 249 patients were treated with PPI at the University of California, San Francisco, and the outcomes were compared with those from a 3D-CRT cohort and the published results of a high-dose CPBRT boost (CPBRTB) trial. For each comparison, subsets of the PPI cohort were selected with patient and disease criteria similar to those of the reference group.
  
  
  RESULTS
  With a median follow-up of 5.3 years, the bNED rate at 5 and 7 years achieved with PPI was 92% and 86%, respectively, using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, and 93% using the PSA nadir plus 2 ng/mL definition. Using the ASTRO definition, a 5-year bNED rate of 78% was achieved for the 3D-CRT patients compared with 94% for a comparable PPI subset and 93% vs. 92%, respectively, using the PSA nadir plus 2 ng/mL definition. The median PSA nadir for patients treated with PPI and 3D-CRT was 0.10 and 0.40 ng/mL, respectively (p < .0001). For the CPBRT comparison, the 5-year bNED rate after a CPBRTB was 91% using the ASTRO definition vs. 93% for a similar group of PPI patients. A greater proportion of PPI patients achieved a lower PSA nadir compared with those achieved in the CPBRTB trial (PSA nadir < or =0.5 ng/mL, 91% vs. 59%, respectively).
  
  
  CONCLUSIONS
  We have demonstrated excellent outcomes in low- to intermediate-risk patients treated with PPI, suggesting at least equivalent 5-year bNED rates and a greater proportion of men achieving lower PSA nadirs compared with 3D-CRT or CPBRTB.
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, School of Medicine, San Francisco, CA, USA.
authors.forename: Siavash
authors.initials: S
authors.lastname: Jabbari
authors.forename: Vivian K
authors.initials: VK
authors.lastname: Weinberg
authors.forename: Katsuto
authors.initials: K
authors.lastname: Shinohara
authors.forename: Joycelyn L
authors.initials: JL
authors.lastname: Speight
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Gottschalk
authors.forename: I-Chow
authors.initials: IC
authors.lastname: Hsu
authors.forename: Barby
authors.initials: B
authors.lastname: Pickett
authors.forename: Patrick W
authors.initials: PW
authors.lastname: McLaughlin
authors.forename: Howard M
authors.initials: HM
authors.lastname: Sandler
authors.forename: Mack
authors.initials: M
authors.lastname: Roach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000528:radiation effects; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D061766:Proton Therapy; D020266:Radiotherapy, Conformal / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D012495:San Francisco; D012669:Seminal Vesicles / Q000528:radiation effects
chemical_list: D017430:Prostate-Specific Antigen