title: High-dose rate brachytherapy compared with open radical prostatectomy for the treatment of high-risk prostate cancer: 10 year biochemical freedom from relapse.
abstract: OBJECTIVE
  • To compare long-term biochemical control of high-risk prostate cancer in those men receiving high-dose rate brachytherapy (HDRB) and radical prostatectomy (RP).
  
  
  METHODS
  • The 10-year biochemical freedom from relapse (BFR) was calculated for 243 patients who underwent either RP or combined therapy with HDRB + external beam radiotherapy + androgen deprivation between 1998 and 2000. •
  
  
  METHODS
  clinical stage ≥ T2b, or Gleason sum ≥ 8, or PSA level of > 20 ng/mL. Groups were appraised using the Kattan nomogram for surgery to calculate progression-free probability (PFP).
  
  
  RESULTS
  • For the RP group (153 patients) the median PSA level was 8.1 ng/mL and the median age was 62.2 years. The median 5- and 10-year predicted PFP for RP was 64% and 56 %, respectively. The 5- and 10-year BFR was 65.5% and 55.4%. There was no significant difference between the predicted and the actual PFP for the RP group (P= 0.525). • For HDRB group (90 patients). The median PSA level was 14.2 ng/mL and the median age was 67.6 years. The median 5- and 10-year predicted PFP for HDRB was 46% and 35%, respectively. The 5- and 10-year BFR was 79.6% and 53.6%. There was a significant improvement between the actual and the predicted PFP for the HDRB group (P= 0.002).
  
  
  CONCLUSIONS
  • Amongst a high-risk cohort, patients undergoing RP performed as predicted by the pre-treatment surgical nomogram, whereas the patients undergoing HDRB performed significantly better than was predicted by the surgical nomogram at 10 years.
authors.affiliation: Prostate Cancer Group, Cancer Research Programme, Garvan Institute of Medical Research, Sydney, NSW, Australia. richardsavdie@gmail.com
authors.forename: Richard
authors.initials: R
authors.lastname: Savdie
authors.forename: James
authors.initials: J
authors.lastname: Symons
authors.forename: Daniel
authors.initials: D
authors.lastname: Spernat
authors.forename: Carlo
authors.initials: C
authors.lastname: Yuen
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Pe Benito
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Haynes
authors.forename: Jayne
authors.initials: J
authors.lastname: Matthews
authors.forename: Krishan K
authors.initials: KK
authors.lastname: Rasiah
authors.forename: Raj S
authors.initials: RS
authors.lastname: Jagavkar
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.forename: Gerald
authors.initials: G
authors.lastname: Fogarty
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Phillip
authors.initials: P
authors.lastname: Brenner
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sutherland
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Stricker
mesh_terms: D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen