title: Biochemical outcomes for patients with intermediate risk prostate cancer treated with I-125 interstitial brachytherapy monotherapy.
abstract: OBJECTIVE
  Routine use of I-125 interstitial brachytherapy (BT) alone in intermediate risk (IR) prostate cancer is controversial. It is often combined with external beam radiotherapy (EBRT). The biochemical outcome of a large cohort of only IR disease treated with BT monotherapy is reported.
  
  
  METHODS
  Between 2003 and 2007, 615 patients with Memorial Sloan-Kettering Cancer Centre (MSKCC) defined IR disease (one risk factor only-T2b, or Gleason score (GS) 7, or raised initial PSA (iPSA) 10.1-20ng/ml) were treated with BT monotherapy. ASTRO (3 consecutive rises) and Phoenix (nadir plus 2) criteria defined biochemical failure. Potential prognostic factors (pre- and post-implant dosimetric indices, GS 3+4 versus 4+3, androgen deprivation therapy (ADT)) were analysed.
  
  
  RESULTS
  Median follow-up was 5.0years. Forty-three patients had stage T2b, 180 had raised iPSA, 392 had GS 7 disease. ADT was received by 108 patients. The 5-year biochemical no evidence of disease (bNED) rates are 87.3% (by ASTRO), 88.6% (by Phoenix). Stratification by risk factor (T2b, GS7, raised iPSA) demonstrated raised iPSA to have poorer outcome only by Phoenix criteria (p=0.0002). Other potential prognostic variables were non-significant.
  
  
  CONCLUSIONS
  Good rates of biochemical control can be achieved in the medium term with BT monotherapy in IR disease. Raised iPSA correlated with a poorer outcome.
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK. Electronic address: anna.tran@christie.nhs.uk.
authors.forename: Anna Thi Huyen
authors.initials: AT
authors.lastname: Tran
authors.forename: Paula
authors.initials: P
authors.lastname: Mandall
authors.forename: Ric
authors.initials: R
authors.lastname: Swindell
authors.forename: P J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: David Martin
authors.initials: DM
authors.lastname: Bottomley
authors.forename: John Paul
authors.initials: JP
authors.lastname: Logue
authors.forename: James Pinson
authors.initials: JP
authors.lastname: Wylie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy*; D012306:Risk; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Intermediate risk; Prostate cancer