title: Brachytherapy improves outcomes in young men (≤60 years) with prostate cancer: A SEER analysis.
abstract: The aim of the study was to compare prostate cancer-specific mortality (PCSM) in young men with clinically localized prostate cancer treated by either external beam radiation (EBRT) alone or brachytherapy with or without external beam radiation.
  
  
  
  Utilizing the Surveillance, Epidemiology and End Results database, 15,505 patients ≤60 years of age diagnosed with prostate cancer between 2004 and 2009 and treated with radiation therapy alone were identified. Incidence of PCSM was determined for both groups and compared using competing risk models.
  
  
  
  The overall 8-year PCSM for the study population was 1.9% (95% confidence interval [CI]: 1.6-2.2). For patients treated with EBRT or brachytherapy with or without external beam, the 8-year PCSM was found to be 2.8% (CI: 2.2-3.4) and 1.2% (CI: 0.9-1.6), respectively (p < 0.001). Univariable analysis demonstrated that brachytherapy was associated with lower PCSM risk (hazard ratio = 0.40; CI: 0.30-0.54; p < 0.001). High Gleason risk category, black race, higher Tumor (T) stage, and higher grade were all associated with greater mortality risk (p < 0.01). On multivariable analysis, brachytherapy continued to be associated with a significantly lower mortality risk (hazard ratio = 0.65; CI: 0.47-0.89; p = 0.008). Subgroup analyses found that among those with Gleason score ≥8, younger patients had increased risk of PCSM (p = 0.001).
  
  
  
  In men ≤60 years of age with prostate cancer, radiation therapy continues to offer excellent outcomes. After adjusting for relevant variables, the use of brachytherapy was associated with reduced PCSM compared to treatment with EBRT alone.
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY. Electronic address: haa9002@nyp.org.
authors.forename: Hani
authors.initials: H
authors.lastname: Ashamalla
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Adel
authors.initials: A
authors.lastname: Guirguis
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Kyle
authors.initials: K
authors.lastname: McCool
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Shauna
authors.initials: S
authors.lastname: McVorran
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Mattes
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Daniel
authors.initials: D
authors.lastname: Metzger
authors.affiliation: Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY.
authors.forename: Clara
authors.initials: C
authors.lastname: Oromendia
authors.affiliation: Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY.
authors.forename: Karla V
authors.initials: KV
authors.lastname: Ballman
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Bahaa
authors.initials: B
authors.lastname: Mokhtar
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Mounzer
authors.initials: M
authors.lastname: Tchelebi
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Katsoulakis
authors.affiliation: Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
authors.forename: Sameer
authors.initials: S
authors.lastname: Rafla
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Outcomes; Prostate cancer; SEER