title: Outcomes of Gleason Score ≤ 8 among high risk prostate cancer treated with 125I low dose rate brachytherapy based multimodal therapy.
abstract: OBJECTIVE
  To investigate the role of low dose rate (LDR) brachytherapy-based multimodal therapy in high-risk prostate cancer (PCa) and analyze its optimal indications.
  
  
  METHODS
  We reviewed the records of 50 high-risk PCa patients [clinical stage ≥ T2c, prostate-specific antigen (PSA) >20 ng/mL, or biopsy Gleason score ≥ 8] who had undergone 125I LDR brachytherapy since April 2007. We excluded those with a follow-up period <3 years. Biochemical recurrence (BCR) followed the Phoenix definition. BCR-free survival rates were compared between the patients with Gleason score ≥ 9 and Gleason score ≤ 8.
  
  
  RESULTS
  The mean initial PSA was 22.1 ng/mL, and mean D90 was 244.3 Gy. During a median follow- up of 39.2 months, biochemical control was obtained in 72% (36/50) of the total patients; The estimated 3-year BCR-free survival was 92% for the patients with biopsy Gleason scores ≤ 8, and 40% for those with Gleason scores ≥ 9 (p<0.001). In Cox multivariate analysis, only Gleason score ≥ 9 was observed to be significantly associated with BCR (p=0.021). Acute and late grade ≥ 3 toxicities were observed in 20% (10/50) and 36% (18/50) patients, respectively.
  
  
  CONCLUSIONS
  Our results showed that 125I LDR brachytherapy-based multimodal therapy in high-risk PCa produced encouraging relatively long-term results among the Asian population, especially in patients with Gleason score ≤ 8. Despite small number of subjects, biopsy Gleason score ≥ 9 was a significant predictor of BCR among high risk PCa patients after brachytherapy.
authors.affiliation: Department of Urology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Park
authors.forename: In Hyuck
authors.initials: IH
authors.lastname: Gong
authors.forename: Don Kyung
authors.initials: DK
authors.lastname: Choi
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Hwang
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Shin
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Oh
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011829:Radiation Dosage; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Prostate cancer; biochemical recurrence; brachytherapy; high risk group
references.citation: J Urol. 2003 Dec;170(6 Pt 2):S21-5; discussion S26-7
references.pmid: 14610406
references.citation: J Clin Oncol. 2008 May 20;26(15):2497-504
references.pmid: 18413638
references.citation: Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):965-74
references.pmid: 16798415
references.citation: Urology. 2010 Sep;76(3):710-4
references.pmid: 19931898
references.citation: World J Urol. 2008 Jun;26(3):219-24
references.pmid: 18335221
references.citation: Brachytherapy. 2010 Oct-Dec;9(4):307-12
references.pmid: 20708980
references.citation: Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):992-6
references.pmid: 20932674
references.citation: Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1261-6
references.pmid: 10889379
references.citation: Int J Radiat Oncol Biol Phys. 2009 Sep 1;75(1):16-22
references.pmid: 19289266
references.citation: Cancer. 2007 Aug 1;110(3):551-5
references.pmid: 17577217
references.citation: Onkologie. 2008 Nov;31(11):599-603
references.pmid: 19145092
references.citation: Brachytherapy. 2007 Jan-Mar;6(1):9-15
references.pmid: 17284380
references.citation: Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):732-6
references.pmid: 21036486
references.citation: Med Phys. 1999 Oct;26(10):2054-76
references.pmid: 10535622
references.citation: Lancet. 2002 Jul 13;360(9327):103-6
references.pmid: 12126818
references.citation: Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):1092-9
references.pmid: 16965872
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):96-101
references.pmid: 17980505
references.citation: Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1341-6
references.pmid: 7713792
references.citation: Int J Radiat Oncol Biol Phys. 2000 Apr 1;47(1):129-36
references.pmid: 10758314
references.citation: Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):341-6
references.pmid: 18597953
references.citation: Brachytherapy. 2009 Apr-Jun;8(2):191-196
references.pmid: 19433320
references.citation: Radiother Oncol. 2007 Apr;83(1):3-10
references.pmid: 17321620
references.citation: J Urol. 2004 Oct;172(4 Pt 1):1297-301
references.pmid: 15371827
references.citation: Eur Urol. 2008 May;53(5):950-9
references.pmid: 17950521
references.citation: Int J Radiat Oncol Biol Phys. 1998 Apr 1;41(1):101-8
references.pmid: 9588923
references.citation: JAMA. 1998 Sep 16;280(11):969-74
references.pmid: 9749478
references.citation: Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):669-77
references.pmid: 16682149
references.citation: Expert Rev Anticancer Ther. 2010 Jul;10(7):1069-76
references.pmid: 20645696
references.citation: Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):57-64
references.pmid: 17084544