title: Biochemical control and toxicity for favorable- and intermediate-risk patients using real-time intraoperative inverse optimization prostate seed implant: Less is more!
abstract: To report the biochemical control rate and clinical outcomes with real-time inverse planning (inverse optimization prostate seed implant [IO-PSI]) for favorable-risk (FR) and intermediate-risk (IR) prostate adenocarcinoma in a community practice setting. This analysis is an extended followup of our initial report, with favorable early biochemical control rate (biochemical nonevidence of disease) of 97% at 4 years.
  
  
  
  Three hundred fifty-seven evaluable patients with FR and IR prostate cancer underwent real-time IO-PSI (iodine-125/145 Gy or palladium-103/120 Gy) between 2001 and 2013.
  
  
  
  With a median followup of 54 months (range, 24-110 months), the absolute biochemical failure free survival of disease was 96%. The 8-year actuarial probability of prostate-specific antigen failure-free survival for FR and IR cohorts was 92.4% and 87%, respectively. Late genitourinary and gastrointestinal toxicity remained low. Late Grade 2 and Grade 3 genitourinary toxicity was 19% and 1%, respectively. Late Grade 2 and 3 rectal bleeding rates were 1% and 0%, respectively. No difference in biochemical control was observed with preimplant short course androgen deprivation or between Gleason score 3 + 4 vs. 4 + 3 patients. No dosimetric parameter was predictive of biochemical failure. Patients with FR had a significantly decreased risk of failure (hazard ratio = 0.26; 95% confidence interval = 0.09-0.78; p = 0.02) compared with those with IR. Patients with a prostate-specific antigen nadir >0.4 ng/mL had an increased risk of failure (hazard ratio = 1.37; 95% confidence interval = 1.27-1.47; p < 0.0001).
  
  
  
  Our initial biochemical and clinical outcomes using real-time IO-PSI persisted with extended followup and support our original hypothesis for use of a reduced number of sources, needles, and total activity, suggesting that with IO, less is more.
authors.affiliation: Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: G
authors.initials: G
authors.lastname: Shukla
authors.affiliation: Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE.
authors.forename: A
authors.initials: A
authors.lastname: Sarkar
authors.affiliation: School of Nursing, University of Pennsylvania, School of Nursing, Philadelphia, PA.
authors.forename: A
authors.initials: A
authors.lastname: Hanlon
authors.affiliation: Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE.
authors.forename: E
authors.initials: E
authors.lastname: Crockett
authors.affiliation: Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE.
authors.forename: H C
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE.
authors.forename: J
authors.initials: J
authors.lastname: Martelli-Raben
authors.affiliation: Brandywine Urology Consultants, Newark, DE.
authors.forename: A
authors.initials: A
authors.lastname: Glick
authors.affiliation: Brandywine Urology Consultants, Newark, DE.
authors.forename: B
authors.initials: B
authors.lastname: Benge
authors.affiliation: Brandywine Urology Consultants, Newark, DE.
authors.forename: M
authors.initials: M
authors.lastname: Lobis
authors.affiliation: Brandywine Urology Consultants, Newark, DE.
authors.forename: S
authors.initials: S
authors.lastname: Terranova
authors.affiliation: Brandywine Urology Consultants, Newark, DE.
authors.forename: T
authors.initials: T
authors.lastname: Desperito
authors.affiliation: Brandywine Urology Consultants, Newark, DE.
authors.forename: D
authors.initials: D
authors.lastname: Cozzolino
authors.affiliation: Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE.
authors.forename: E
authors.initials: E
authors.lastname: Kemmerer
authors.affiliation: Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA; Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE.
authors.forename: F
authors.initials: F
authors.lastname: Mourtada
authors.affiliation: Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE. Electronic address: araben@christianacare.org.
authors.forename: A
authors.initials: A
authors.lastname: Raben
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010165:Palladium / Q000627:therapeutic use*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D011868:Radioisotopes / Q000627:therapeutic use*; D011879:Radiotherapy Dosage; D012307:Risk Factors
chemical_list: D000726:Androgen Antagonists; D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; C000615531:Palladium-103; D017430:Prostate-Specific Antigen; C000614960:Iodine-125
keywords: Biochemical control; Brachytherapy; Intraoperative; Prostate cancer