title: Ten-year outcomes using low dose rate brachytherapy for localised prostate cancer: An update to the first Australian experience.
abstract: BACKGROUND
  To report long-term prostate-specific antigen (PSA) and toxicity outcomes for patients with localised prostate cancer treated with Iodine-125 permanent implantation at a single Australian centre.
  
  
  METHODS
  Between September 1994 and November 2007, 207 patients at Sir Charles Gairdner Hospital with localised prostate cancer were consecutively treated with Iodine-125 permanent interstitial implantation. Post-therapy assessment was performed three times a month and included clinical review and biochemical (PSA) evaluation. PSA progression was evaluated using the Phoenix (nadir + 2.0) definition. Treatment-related morbidity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 guidelines. The rate of biochemical failure was calculated by Kaplan-Meier plots. Univariate and multivariate analyses were performed to evaluate outcomes by pre-treatment clinical prognostic factors and radiation dosimetry.
  
  
  RESULTS
  Median follow-up was 7.8 years. The 10-year biochemical disease-free survival (bDFS) for the entire cohort was 89%. Ten-year bDFS estimates by pre-treatment risk group were 96% for low-risk, 83% for intermediate-risk and 50% for high-risk disease. On multivariate analysis, pre-treatment PSA was an independent predictor of bDFS. D90 dose did not show a statistically significant effect on bDFS. The peak incidences of late grade 3 or higher urinary and rectal toxicities were 10.7% and 1.1% respectively.
  
  
  CONCLUSIONS
  Excellent long-term biochemical control was demonstrated with Iodine-125 permanent interstitial implantation in appropriately selected patients with prostate cancer. The results of our single centre experience are comparable with those of other single institutions.
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Wilson
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Waterhouse
authors.affiliation: Barwon Health Biostatistics Unit, University Hospital Geelong, Geelong, Victoria, Australia.|School of Medicine, Deakin University, Geelong, Victoria, Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lane
authors.affiliation: Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Haworth
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Stanley
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Shannon
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Joseph
mesh_terms: D000368:Aged; D001315:Australia; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy*; D011829:Radiation Dosage; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen
keywords: biochemical control; brachytherapy; dosimetry; prostate cancer; toxicity