title: Gleason score 7 prostate cancer treated with interstitial brachytherapy with or without supplemental external beam radiation and androgen deprivation therapy: is the primary pattern on needle biopsy prognostic?
abstract: OBJECTIVE
  To evaluate the effect of primary Gleason pattern on biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) in Gleason 7 prostate cancer patients treated with low-dose-rate (LDR) interstitial brachytherapy with or without supplemental external beam radiation therapy and androgen deprivation therapy.
  
  
  METHODS
  We retrospectively reviewed the medical records of 932 consecutive patients with biopsy-confirmed Gleason 7 prostate cancer who received LDR interstitial brachytherapy as a component of their definitive treatment regimen. Treatment outcomes were compared between patients with primary Gleason pattern 3 and 4.
  
  
  RESULTS
  With a median followup of 7.4 years, the 10- and 14-year bPFS, CSS, and OS for the entire Gleason 7 study group were 95.7/95.7%, 98.6/98.6% and 77.2/64.3%, respectively. When biochemical control was evaluated as a function of primary Gleason pattern, the primary pattern 3 had a statistically higher 10- and 14-year bPFS (97.8/97.8% vs. 93.1/93.1%, p=0.006). The Gleason pattern 3 patients also trended toward a higher 10- and 14-year CSS (99.3/99.3% vs. 96.9/96.9%, p=0.058). OS was not statistically different between the two Gleason 7 cohorts.
  
  
  CONCLUSIONS
  Gleason 7 prostate cancer patients treated with LDR interstitial brachytherapy have an excellent long-term outcome. There was a small but statistically significant advantage in bPFS and a trend toward improved CSS in patients with a primary Gleason pattern of 3.
authors.affiliation: Department of Radiation Oncology, Tacoma/Valley Radiation Oncology Centers, Tacoma, WA, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Bittner
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Merrick
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Butler
authors.forename: Robert W
authors.initials: RW
authors.lastname: Galbreath
authors.forename: Edward
authors.initials: E
authors.lastname: Adamovich
authors.forename: Kent E
authors.initials: KE
authors.lastname: Wallner
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D001918:Brachytherapy / Q000401:mortality*; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D015995:Prevalence; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D020266:Radiotherapy, Conformal / Q000401:mortality*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology
chemical_list: D000726:Androgen Antagonists