title: Outcomes for patients with high-grade prostate cancer treated with a combination of brachytherapy, external beam radiotherapy and hormonal therapy.
abstract: OBJECTIVE
  To assess the outcomes for patients with Gleason score 8-10 prostate cancer treated with brachytherapy, external beam radiotherapy (EBRT) and hormonal therapy (HT).
  
  
  METHODS
  In all, 181 patients with Gleason scores 8-10 prostate cancer were treated from 1994 to 2006 with a (103)Pd implant (prescription dose 100 Gy), 45 Gy of EBRT and 9 months of HT. The median (range) follow-up was 65 (24-150) months; freedom from biochemical failure (FBF) rates were calculated using the Phoenix definition.
  
  
  RESULTS
  The 8-year actuarial FBF, freedom from distant metastases, prostate-cancer specific survival and overall survival were 73%, 80%, 87% and 79%, respectively. The pretreatment prostate-specific antigen (PSA) level significantly affected FBF, with 8-year rates of 72%, 82% and 58% for patients with PSA level of <or=10, >10-20 and >20 ng/mL, respectively (P = 0.006). The PSA level had no significant effect on rates of distant metastases. The Gleason score had the most significant affect on FBF in a multivariate analysis, and was the only factor to significantly affect rates of distant metastases; the 8-year FBF rates were 84%, 55% and 30% for scores of 8, 9 and 10, respectively (P = 0.003). The corresponding freedom from distant metastases and prostate-cancer specific survival rates were 86%, 76%, 30% (P < 0.001) and 92%, 80%, 62.5% (P = 0.003), respectively.
  
  
  CONCLUSIONS
  The 8-year outcomes after this regimen showed favourable biochemical and distant control, as well disease-specific survival rates for patients with Gleason scores of 8-10. This treatment approach should be considered as a viable option for this subset of patients with high-risk disease.
authors.affiliation: Departments of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, NY 10029, 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: Simon J
authors.initials: SJ
authors.lastname: Hall
authors.forename: Nelson N
authors.initials: NN
authors.lastname: Stone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001918:Brachytherapy; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen