title: Long-term outcome for prostate cancer using pseudo pulse-dosed rate brachytherapy, external beam radiotherapy, and hormones.
abstract: OBJECTIVE
  We report the long-term outcomes of pulse-dose rate (PDR) brachytherapy used in a nonstandard style (pseudo-PDR) with an high-dose rate brachytherapy technique in conjunction with external beam radiotherapy (EBRT) and hormonal manipulation on prostate cancer (PC).
  
  
  METHODS
  We treated 253 patients with Stage T1-T3 N0M0 PC, between December 1999 and March 2006. All patients received neoadjuvant androgen deprivation for a median 6 months. Treatment consisted of three pulses of pseudo-PDR brachytherapy to a median dose of 18Gy with 50.4Gy in 28 fractions of EBRT.
  
  
  RESULTS
  At a median 6 years followup, (range, 1-11 years), 5-year overall survival was 92%, and PC-specific survival was 96%. The 5-year biochemical control (biochemical no evidence of disease) by the Phoenix definition for low-, intermediate-, and high-risk groups was 95%, 90%, and 71%, respectively (p<0.00001). At 6 years, the incidence of Radiotherapy Oncology Group Grade 2 and 3 genitourinary toxicity was 1% and 6%; Radiotherapy Oncology Group Grade 2 and 3 gastrointestinal toxicity was 4% and 0%. Erectile preservation at 3 years was 58%. The Phoenix definition best predicted clinical failure with a high specificity (94%).
  
  
  CONCLUSIONS
  Pseudo-PDR brachytherapy plus EBRT with limited neoadjuvant hormonal manipulation is an effective treatment option in localized PC, with minimal and tolerable morbidity and provides excellent control. This technique of a modified PDR-delivery technique appears as effective as high-dose rate therapy.
authors.affiliation: Department of Radiotherapy, Mater Hospital, North Sydney, New South Wales, Australia; Northern Clinical School, University of Sydney, New South Wales, Australia. Electronic address: michael.izard@cancer.com.au.
authors.forename: Michael Anthony
authors.initials: MA
authors.lastname: Izard
authors.forename: Lucinda May
authors.initials: LM
authors.lastname: Morris
authors.forename: Wai-Yin
authors.initials: WY
authors.lastname: Wan
authors.forename: Jarad
authors.initials: J
authors.lastname: Martin
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D019583:Dose Fractionation, Radiation; D004359:Drug Therapy, Combination; D006801:Humans; D015994:Incidence; D007986:Luteinizing Hormone / Q000819:agonists / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D011832:Radiation Injuries; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000379:methods; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D007986:Luteinizing Hormone; D017430:Prostate-Specific Antigen
keywords: Brachytherapy; HDR; High dose rate; PDR; Prostatic neoplasm; Pulsed dose rate