title: Is modern external beam radiotherapy with androgen deprivation therapy still a viable alternative for prostate cancer in an era of robotic surgery and brachytherapy: a comparison of Australian series.
abstract: BACKGROUND
  We compare the results of modern external-beam radiotherapy (EBRT), using combined androgen deprivation and dose-escalated intensity-modulated radiotherapy with MRI-CT fusion and daily image guidance with fiducial markers (DE-IG-IMRT), with recently published Australian series of brachytherapy and surgery.
  
  
  METHODS
  Five-year actuarial biochemical disease-free survival (bDFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCaSS) were calculated for 675 patients treated with DE-IG-IMRT and androgen deprivation therapy (ADT). Patients had intermediate-risk (IR) and high-risk (HR) disease. A search was conducted identifying Australian reports from 2005 onwards of IR and HR patients treated with surgery or brachytherapy, reporting actuarial outcomes at 3 years or later.
  
  
  RESULTS
  With a median follow-up of 59 months, our 5-year bDFS was 93.3% overall: 95.5% for IR and 91.3% for HR disease. MFS was 96.9% overall (99.0% IR, 94.9% HR), and PCaSS was 98.8% overall (100% IR, 97.7% HR). Prevalence of Grade 2 genitourinary and gastrointestinal toxicity at 5 years was 1.3% and 1.6%, with 0.3% Grade 3 genitourinary toxicity and no Grade 3 gastrointestinal toxicity. Eight reports of brachytherapy and surgery were identified. The HDR brachytherapy series' median 5-year bDFS was 82.5%, MFS 90.0% and PCaSS 97.9%. One surgical series reported 5-year bDFS of 65.5% for HR patients. One LDR series reported 5-year bDFS of 85% for IR patients.
  
  
  CONCLUSIONS
  Modern EBRT is at least as effective as modern Australian surgical and brachytherapy techniques. All patients considering treatment for localised prostate cancer should be referred to a radiation oncologist to discuss EBRT as an equivalent option.
authors.affiliation: Radiation Oncology, North Coast Cancer Institute, Port Macquarie, New South Wales, Australia.
authors.forename: Shea William
authors.initials: SW
authors.lastname: Wilcox
authors.forename: Noel J
authors.initials: NJ
authors.lastname: Aherne
authors.forename: Craig Steven
authors.initials: CS
authors.lastname: McLachlan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McKay
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Last
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shakespeare
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D001918:Brachytherapy / Q000401:mortality*; D059248:Chemoradiotherapy / Q000401:mortality*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000628:therapy*; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000706:statistics & numerical data*; D025321:Surgery, Computer-Assisted / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists
keywords: brachytherapy; external beam radiotherapy; intensity-modulated radiotherapy prostate cancer; radical prostatectomy