title: Primary Gleason grade 4 impact on biochemical recurrence after permanent interstitial brachytherapy in Japanese patients with low- or intermediate-risk prostate cancer.
abstract: OBJECTIVE
  To reveal a predictive factor for biochemical recurrence (BCR) after permanent prostate brachytherapy (PPB) using iodine-125 seed implantation in patients with localized prostate cancer classified as low or intermediate risk based on National Comprehensive Cancer Network (NCCN) guidelines.
  
  
  METHODS
  From January 2004 to December 2009, 414 consecutive Japanese patients with clinically localized prostate cancer classified as low or intermediate risk based on the NCCN guidelines were treated with PPB. The clinical factors including pathological data reviewed by a central pathologist and follow-up data were prospectively collected. Kaplan-Meier and Cox regression analyses were used to assess the factors associated with BCR.
  
  
  RESULTS
  Median follow-up was 36.5 months. The 2-, 3-, 4-, and 5-year BCR-free rates using the Phoenix definition were 98.3%, 96.0%, 91.6%, and 87.0%, respectively. On univariate analysis, the Gleason score, especially primary Gleason grade 4 in biopsy specimens, was a strong predicting factor (p < 0.0001), while age, initial prostate-specific antigen (PSA) level, T stage, and minimal dose delivered to 90% of the prostate volume (D90) were insignificant. Multivariate analysis indicated that a primary Gleason grade 4 was the most powerful prognostic factor associated with BCR (hazard ratio = 6.576, 95% confidence interval, 2.597-16.468, p < 0.0001).
  
  
  CONCLUSIONS
  A primary Gleason grade 4 carried a worse BCR prognosis than the primary grade 3 in patients treated with PPB. Therefore, the indication for PPB in patients with a Gleason sum of 4 + 3 deserves careful and thoughtful consideration.
authors.affiliation: Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Uesugi
authors.forename: Takashi
authors.initials: T
authors.lastname: Saika
authors.forename: Kohei
authors.initials: K
authors.lastname: Edamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nose
authors.forename: Makoto
authors.initials: M
authors.lastname: Kobuke
authors.forename: Shin
authors.initials: S
authors.lastname: Ebara
authors.forename: Fernand
authors.initials: F
authors.lastname: Abarzua
authors.forename: Norihisa
authors.initials: N
authors.lastname: Katayama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yanai
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Nasu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kumon
mesh_terms: D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D016001:Confidence Intervals; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000532:radiotherapy*; D047368:Tumor Burden
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen