title: High-Dose-Rate Monotherapy for Localized Prostate Cancer: 10-Year Results.
abstract: OBJECTIVE
  High-dose-rate (HDR) brachytherapy was originally used with external beam radiation therapy (EBRT) to increase the dose to the prostate without injuring the bladder or rectum. Numerous studies have reported HDR brachytherapy is safe and effective. We adapted it for use without EBRT for cases not requiring lymph node treatment.
  
  
  METHODS
  We entered the patient demographics, disease characteristics, and treatment parameters into a prospective registry and serially added follow-up data for 448 men with low-risk (n=288) and intermediate-risk (n=160) prostate cancer treated from 1996 to 2009. Their median age was 64 years (range 42-90). The median prostate-specific antigen (PSA) level was 6.0 ng/mL (range 0.2-18.2). The Gleason score was ≤6 in 76% and 7 in 24%. The median dose was 43.5 Gy in 6 fractions. The clinical and biochemical disease control and survival rates were calculated. Adverse events were graded according to the Common Toxicity Criteria of Adverse Events.
  
  
  RESULTS
  The median follow-up period was 6.5 years (range 0.3-15.3). The actuarial 6- and 10-year PSA progression-free survival was 98.6% (95% confidence interval [CI] 96.9%-99.4%) and 97.8% (95% CI 95.5%-98.9%). Overall survival at 10 years was 76.7% (95% CI 69.9%-82.2%). The local control, distant metastasis-free survival, and cause-specific survival were 99.7% (95% CI 97.9%-99.9%), 98.9% (95% CI 96.3%-99.7%), and 99.1% (95% CI 95.8%-99.8%). T stage, initial PSA level, Gleason score, National Comprehensive Cancer Network risk group, patient age, and androgen deprivation therapy did not significantly correlate with disease control or survival. No late grade 3 to 4 rectal toxicities developed. Late grade 3 to 4 genitourinary toxicity occurred in 4.9% (grade 3 in 4.7%).
  
  
  CONCLUSIONS
  HDR monotherapy is a safe and highly effective treatment of low- and intermediate-risk prostate cancer.
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hauswald
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Kamrava
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Fallon
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Pin-Chieh
authors.initials: PC
authors.lastname: Wang
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Sang-June
authors.initials: SJ
authors.lastname: Park
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Thanh
authors.initials: T
authors.lastname: Van
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Lalaine
authors.initials: L
authors.lastname: Borja
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steinberg
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California. Electronic address: JDemanes@mednet.ucla.edu.
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Demanes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D003075:Coitus; D018572:Disease-Free Survival; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000473:pathology; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen