title: Comparison of high-dose proton radiotherapy and brachytherapy in localized prostate cancer: a case-matched analysis.
abstract: OBJECTIVE
  To report a case-matched analysis comparing high-dose external-beam radiation (EBRT) for prostate cancer delivered on Proton Radiation Oncology Group (PROG) 95-09, a randomized trial, with permanent prostate brachytherapy over the same era.
  
  
  METHODS
  From 1996 to 1999, 196 patients were accrued to the high-dose arm (79.2 Gray equivalent (GyE) using photons and protons) of PROG 95-09 at the Massachusetts General Hospital and Loma Linda University Medical Center. Entry criteria specified T1-2 and prostate-specific antigen ≤ 15 ng/mL. When Gleason score >7 was excluded, 177 men were left for case matching. At Massachusetts General Hospital, 203 similar patients were treated by a single brachytherapist from 1997 to 2002. Minimum follow-up was 3 years. Case matching, based on T stage, Gleason score, prostate-specific antigen, and age resulted in 141 matches (282 patients). Median follow-up was 8.6 and 7.4 years for EBRT and brachytherapy, respectively. The primary endpoint was biochemical failure (BF).
  
  
  RESULTS
  Using the Phoenix definition, the 8-year BF rates were 7.7% and 16.1% for EBRT and brachytherapy, respectively (p = 0.42). A stratified analysis was performed by risk group. In the EBRT group, 113 and 28 patients were low and intermediate risk, respectively. In the brachytherapy group, 118 and 23 were. When stratified by risk group, the BF rates were similar by either technique.
  
  
  CONCLUSIONS
  High-dose EBRT and brachytherapy result in similar BF rates for men with localized prostate cancer. Comparative quality-of-life and cost-effectiveness studies are warranted.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA. jcoen@partners.org
authors.forename: John J
authors.initials: JJ
authors.lastname: Coen
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Zietman
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Rossi
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Grocela
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: William U
authors.initials: WU
authors.lastname: Shipley
mesh_terms: D000367:Age Factors; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002140:California; D016022:Case-Control Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D060787:Neoplasm Grading; D010165:Palladium / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D061766:Proton Therapy; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D012669:Seminal Vesicles; D017211:Treatment Failure
chemical_list: D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen