title: Permanent prostate brachytherapy with or without supplemental external beam radiotherapy as practiced in Japan: outcomes of 1300 patients.
abstract: OBJECTIVE
  To report outcomes for men treated with iodine-125 ((125)I) prostate brachytherapy (BT) at a single institution in Japan.
  
  
  METHODS
  Between 2003 and 2009, 1313 patients (median age, 68 years) with clinically localized prostate cancer were treated with (125)I BT. Median prostate-specific antigen level was 7.6 ng/mL (range, 1.1-43.3). T-stage was T1c in 60%, T2 in 39%, and T3 in 1% of patients. The Gleason score was <7, 7, and >7 in 49%, 45%, and 6% of patients, respectively. Neoadjuvant androgen deprivation therapy was used in 40% of patients and combined external beam radiotherapy of 45 Gy in 48% of patients. Postimplant dosimetry was performed after 30 days after implantation, with total doses converted to the biologically effective dose. Survival functions were calculated by the Kaplan-Meier method and Cox hazard model.
  
  
  RESULTS
  Median followup was 67 months (range, 6-126). The 7-year biochemical freedom from failure for low-, intermediate-, and selected high-risk prostate cancers were 98%, 93%, and 81%, respectively (p < 0.001). Multivariate analysis identified the Gleason score, initial prostate-specific antigen level, positive biopsy rate, dose, and neoadjuvant androgen deprivation therapy as predictors for biochemical freedom from failure. The 7-year actuarial developing Grade 3+ genitourinary and gastrointestinal toxicity was 2% and 0.3%, respectively. Forty-four percent patients with normal baseline potency retained normal erectile function at 5 years.
  
  
  CONCLUSIONS
  (125)I prostate BT is a highly effective treatment option for low-, intermediate-, and selected high-risk prostate cancers. Side effects were tolerable. An adequate dose may be required to achieve successful biochemical control.
authors.affiliation: Department of Radiology, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan. Electronic address: ayorozu@aol.com.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Yorozu
authors.affiliation: Department of Radiology, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Kuroiwa
authors.affiliation: Department of Radiology, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan.
authors.forename: Akane
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Radiology, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Toya
authors.affiliation: Department of Urology, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Urology, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Nishiyama
authors.affiliation: Department of Urology, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan.
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Yagi
authors.affiliation: Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Ohashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001706:Biopsy; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D011874:Radiometry / Q000379:methods; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Dose–response; Iodine-125; Low-dose-rate; Permanent seed implantation; Prostate cancer; Radiotherapy