title: Risk of all-cause and prostate cancer-specific mortality after brachytherapy in men with small prostate size.
abstract: BACKGROUND
  Brachytherapy for prostate cancer can be technically challenging in men with small prostates (≤20 cc), but it is unknown whether their outcomes are different than those of men with larger prostates.
  
  
  METHODS
  We studied 6,416 men treated with brachytherapy in one of 21 community-based practices. Cox regression and Fine and Gray's regression were used to determine whether volume ≤20 cc was associated with a higher risk of all-cause mortality (ACM) or prostate cancer-specific mortality (PCSM), respectively, after adjustment for other known prognostic factors.
  
  
  RESULTS
  443 patients (6.9%) had a prostate volume ≤20 cc. After a median follow-up of 2.91 years (interquartile range, 1.06-4.79), volume ≤20 cc was associated with a significantly higher risk of ACM (adjusted hazard ratio = 1.33 [95% CI 1.08-1.65], p = 0.0085) with 3-year estimates of ACM for ≤20 cc vs. >20 cc of 13.0% vs. 6.9% (p = 0.028). Only 23 men (0.36%) have died of prostate cancer, and no difference was seen in PCSM by volume (p = 0.4).
  
  
  CONCLUSIONS
  Men with small prostates at the time of implant had a 33% higher risk of ACM, and the underlying cause of this remains uncertain. No increase in PCSM was observed in men with volume ≤20cc, suggesting that a small prostate should not in itself be a contraindication for brachytherapy, but inasmuch as absolute rates of PCSM were small, further follow-up will be needed to confirm this finding.
authors.affiliation: Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA. E-pnguyen@LROC.harvard.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Ming H
authors.initials: MH
authors.lastname: Chen
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Dosoretz
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Katin
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Braccioforte
authors.forename: Rudi
authors.initials: R
authors.lastname: Ross
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Salenius
authors.forename: Philip W
authors.initials: PW
authors.lastname: Kantoff
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods; D002423:Cause of Death; D000075202:Contraindications; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009929:Organ Size; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D012044:Regression Analysis
chemical_list: D000726:Androgen Antagonists