title: High-dose-rate brachytherapy monotherapy without androgen deprivation therapy for intermediate-risk prostate cancer.
abstract: Outcomes using high-dose-rate (HDR) brachytherapy monotherapy (without androgen deprivation therapy or external beam radiation therapy) for National Comprehensive Cancer Network-defined intermediate-risk (IR) patients are limited. We report our long-term data using HDR monotherapy for this patient population.
  
  
  
  One-hundred ninety IR prostate cancer patients were treated 1996-2013 with HDR monotherapy. Biochemical prostate-specific antigen (PSA) failure was per the Phoenix definition. Acute and late genitourinary and gastrointestinal toxicities were graded according to Common Toxicity Criteria of Adverse Events, version 4. Kaplan-Meier (KM) biochemical progression-free survival (BPFS), cause-specific survival, and overall survival rates were calculated. Univariate analyses were performed to determine relationships with BPFS. The median patient age was 66 years (43-90), and the median initial PSA was 7.4 ng/mL. The Gleason score was ≤6 in 26%, 3 + 4 in 62%, and 4 + 3 in 12%. The median treatment BED1.5was 254 Gy; 83% of patients were treated with a dose of 7.25 Gy × six fractions delivered in two separate implants.
  
  
  
  With a median follow-up of 6.2 years, KM BPFS at 5/8 years was 97%/90%, cause-specific survival at 8 years was 100%, and overall survival at 5/8 years was 93%/88%. Late genitourinary toxicities were 36.3% Grade 1, 18.9% Grade 2, and 3.7% Grade 3. Late gastrointestinal toxicities were 6.3% Grade 1, 1.1% Grade 2, and no Grade ≥3. Of the patients with no sexual dysfunction before treatment, 68% maintained potency. Age, initial PSA, T stage, Gleason score, prostate volume, and percent positive cores did not correlate with BPFS. Stratifying by favorable vs. unfavorable IR groups did not affect BPFS.
  
  
  
  HDR brachytherapy monotherapy represents a safe and highly effective treatment for IR prostate cancer patients with long-term follow-up.
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA; Department of Radiation Oncology, University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ. Electronic address: patels2010@gmail.com.
authors.forename: Shyamal
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Demanes
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Omar
authors.initials: O
authors.lastname: Ragab
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Mingle
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Darlene
authors.initials: D
authors.lastname: Veruttipong
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Nguyen
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Sang-June
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Marks
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Allan
authors.initials: A
authors.lastname: Pantuck
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D052801:Male Urogenital Diseases / Q000209:etiology; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: Brachytherapy without external beam radiation therapy; HDR brachytherapy monotherapy; High-dose-rate brachytherapy for prostate cancer; Intermediate prostate cancer without androgen deprivation therapy; Intermediate-risk prostate cancer; Prostate brachytherapy