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Background: To compare the PSA value at the last follow-up of patients who underwent prostate low-dose rate brachytherapy (LDR-BT) with that of patients who underwent intensity-modulated radiation therapy (IMRT).Methods: A total of 610 prostate cancer patients (cT1c-3bN0M0) were enrolled, and 445 of them underwent LDR-BT, while 165 received IMRT (74-76 Gy). The median follow-up period of these two groups was 75 months (LDR-BT) and 78 months (IMRT), respectively. We also evaluated the biochemical recurrence (BCR)-free rate using two definitions (Phoenix definition and PSA ≥ 0.2 ng/mL).Results: The percentage of patients who achieved PSA < 0.2 ng/mL at the last follow-up was 77.5% in the LDR-BT group and 49.7% in the IMRT group (p < 0.001). Among patients with a normal testosterone level at the last follow-up, the percentage of those who achieved PSA < 0.2 ng/mL at the last follow-up was 79.2% in the LDR-BT group and 32.1% in the IMRT group (p < 0.001). The 5-year BCR-free rate by the Phoenix definition in the IMRT and LDR-BT groups was 89.5 and 95.0% (p < 0.001), respectively. On the other hand, the 5-year BCR-free rate using the definition of PSA ≥ 0.2 ng/mL was 59.1 and 80.1% in the IMRT and LDR-BT groups, respectively (p < 0.001).Conclusions: The PSA value at the last follow-up of LDR-BT was significantly lower than that of IMRT, and this result was particularly marked in patients with a normal testosterone level at the last follow-up. [ABSTRACT FROM AUTHOR]

Background and purpose The brachytherapy dose algorithm of the American Association of Physicists in Medicine Task Group (TG) Report 43 overrides all tissue materials with water. In reality, dose discrepancies will occur around tissue calcifications. This study investigates these perturbations in low dose rate prostate brachytherapy dosimetry. Materials and methods 43 cancer patients with prostatic calcifications are identified. Geant4 Monte Carlo (MC) simulations are made with materials assigned based on TG186 recommendations. Five dose calculation scenarios are presented: MC in water (MCW), MCW with calcifications, (MCCA), MCCA with seeds (MCCA SEED ) and full tissue definition and seeds with dose to medium in medium (FMC) and dose to water in medium (FMC- D w,m ). Results The mean FMC prostate D90 (V100) difference relative to TG43 is −6.4% (range [−1.8, −14.1]) (−2.6% [−0.3, −6.7]). For MCCA we obtained −3.9% [−1.0, −8.7] (−1.5% [−0.2, −4.1]). The mean urethra D10 difference is −4.5% [−1.3, −9.9] for FMC, −2.4% [−0.7, −5.1] with MCCA. FMC- D w,m D90 has a −0.45% smaller dose difference than FMC on average. The calcification/prostate volume ratio is a good predictor of dose perturbation ( R 2 = 0.75). Conclusion Based on these results, calcifications alter the dose coverage and may have severe dose perturbation that requires recalculation. [ABSTRACT FROM AUTHOR]

Objectives To analyze mid-term oncological outcomes of low-dose rate brachytherapy in Japanese patients. Methods Between 2003 and 2010, 604 consecutive patients with clinically localized prostate cancer were treated with low-dose rate brachytherapy at Jikei University Hospital in Tokyo, Japan. Median follow up was 48 months. Of these patients, 260 (43%) were treated with neoadjuvant therapy, 45 (7.5%) with adjuvant hormonal therapy and 75 (12.4%) with supplemental external beam radiation therapy. Biochemical recurrence was defined as the prostate-specific antigen nadir plus 2 ng/mL. Results Of the 604 patients, 219 (36.2%) were low risk, 361 (59.8%) were intermediate risk and 24 (4.0%) had high-risk disease. The median biologically effective dose was 174.4 Gy2. At 8 years, biochemical recurrence-free survival, cancer-specific survival, and overall survival were 82.2%, 100% and 95.6%, respectively. Biochemical recurrence-free survival at 8 years was 89.9%, 79.4% and 52.5%, for the low-, intermediate-, and high-risk groups, respectively. Biochemical recurrence-free survival for the high-risk group was significantly lower than the low- and intermediate-risk groups ( P < 0.001). Biochemical recurrence-free survival did not differ significantly by biologically effective dose stratification. In multivariate analysis, younger age ( P = 0.045), higher prostate-specific antigen ( P = 0.004), higher Gleason score ( P = 0.006) and higher clinical T stage ( P = 0.008) were significant covariates associated with biochemical recurrence. The addition of hormonal therapy or external beam radiation therapy was associated with significantly better outcomes than low-dose rate brachytherapy monotherapy ( P = 0.0021 and 0.010). Just four patients experienced G3 genitourinary or gastrointestinal toxicity. Conclusions Low-dose rate brachytherapy results in excellent mid-term oncological outcomes and acceptable toxicity in Japanese patients. In our experience, biologically effective dose does not represent a significant predictor for biochemical recurrence. [ABSTRACT FROM AUTHOR]

Objective: To establish a multi-centre database of a large number of patients treated with brachytherapy across Europe.Methods: A total of 1175 patient files were registered in the database and the completeness of the data on these patients resulted in the majority being included in the analysis.Results: The database of patients treated with brachytherapy across Europe indicates that optimal patient selection for this procedure has been made, both in terms of outcome and side-effects, which will be subject of future analyses. This should enable refinement of the treatment choice and administration as well as provide useful guidance to other centres that want to establish this procedure for their patients. It will also set the ground for prospective studies.Conclusions: The established database indicates that brachytherapy as a treatment option for prostate cancer is well established in many centres. [Copyright &y& Elsevier]