title: Additional androgen deprivation makes the difference: Biochemical recurrence-free survival in prostate cancer patients after HDR brachytherapy and external beam radiotherapy.
abstract: BACKGROUND
  The role of additional androgen deprivation therapy (ADT) in prostate cancer (PCa) patients treated with combined HDR brachytherapy (HDR-BT) and external beam radiotherapy (EBRT) is still unknown.
  
  
  METHODS
  Consecutive PCa patients classified as D'Amico intermediate and high-risk who underwent HDR-BT and EBRT treatment ± ADT at our institution between January 1999 and February 2009 were assessed. Multivariable Cox regression models predicting biochemical recurrence (BCR) were performed. BCR-free survival was assessed with Kaplan-Meier analyses.
  
  
  RESULTS
  Overall, 392 patients were assessable. Of these, 221 (56.4 %) underwent trimodality (HDR-BT and EBRT and ADT) and 171 (43.6 %) bimodality (HDR-BT and EBRT) treatment. Additional ADT administration reduced the risk of BCR (HR: 0.4, 95 % CI: 0.3-0.7, p < 0.001). D'Amico high-risk patients had superior BCR-free survival when additional ADT was administered (log-rank p < 0.001). No significant difference for BCR-free survival was recorded when additional ADT was administered to D'Amico intermediate-risk patients (log-rank p = 0.2).
  
  
  CONCLUSIONS
  Additional ADT administration improves biochemical control in D'Amico high-risk patients when HDR-BT and EBRT are combined. Physicians should consider the oncological benefit of ADT administration for these patients during the decision-making process.
authors.affiliation: Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, schiffmann@martini-klinik.de.
authors.forename: Jonas
authors.initials: J
authors.lastname: Schiffmann
authors.forename: Hans
authors.initials: H
authors.lastname: Lesmana
authors.forename: Pierre
authors.initials: P
authors.lastname: Tennstedt
authors.forename: Burkhard
authors.initials: B
authors.lastname: Beyer
authors.forename: Katharina
authors.initials: K
authors.lastname: Boehm
authors.forename: Volker
authors.initials: V
authors.lastname: Platz
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Georg
authors.initials: G
authors.lastname: Salomon
authors.forename: Cordula
authors.initials: C
authors.lastname: Petersen
authors.forename: Andreas
authors.initials: A
authors.lastname: Krüll
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schwarz
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods*; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D020266:Radiotherapy, Conformal / Q000379:methods*
chemical_list: D000726:Androgen Antagonists