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Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 406-410

Feasibility of brachytherapy as monotherapy for high-volume, low-risk prostate cancer

1 Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
2 Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA
3 Department of Urology, Saint Anne's Hospital, Fall River, MA, USA
4 Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

Correspondence Address:
Mark D Hurwitz
Bodine Center, Suite G-301, 111 South 11th Street, Philadelphia, PA 19107
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.180083

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Background: We sought to determine whether patients with high-volume, low-risk prostate cancer are suitable candidates for ultrasound-guided brachytherapy, monotherapy alone, without supplemental external beam radiation. Materials and Methods: The study cohort comprised 200 consecutive patients who received ultrasound.guided monotherapy from November 02, 1998 to March 26, 2010. Real.time intraoperative treatment planning was performed for all patients. 145. Gy with I125 was prescribed to the prostate with no margin. The primary endpoint was time to prostate-specific antigen. (PSA) failure using the phoenix definition. Cox multivariable regression analysis was used to determine the factors significantly associated with time to PSA failure. Results: Median follow-up was 59 months (range 1.2–146.8 months). The median PSA was 5.0 ng/ml. For the overall cohort, both 5- and 8-year PSA failure-free survival was 92.3% (95% confidence interval [95% CI]: 86.5–95.7%). Low-risk patients per the NCCN criteria had 5- and 8-year PSA failure-free survival of 93.6%. On cox multivariable analysis, only baseline PSA (adjusted hazard ratio: 1.29 [95% CI: 1.02–1.65], P = 0.036) was associated with outcome. Among patients with <33% cores positive, 33–<50% cores positive, and ≥50% cores positive, the 5-year PSA failure-free survival was 92.3% (95% CI: 85.1–96.1%), 91.0% (95% CI: 68.5–97.6%), and 93.3% (95% CI: 61.2–99.0%), respectively. Conclusions: Our analysis indicates that patients with a high number of cores positive for cancer can be adequately treated with modern brachytherapy as monotherapy and be spared the additional morbidity and cost of supplemental external beam radiation or androgen deprivation therapy.

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