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BJU Int. 2009 Dec;104(11):1631-6. doi: 10.1111/j.1464-410X.2009.08661.x. Epub 2009 Jun 2.

Outcomes for patients with high-grade prostate cancer treated with a combination of brachytherapy, external beam radiotherapy and hormonal therapy.

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Departments of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, NY 10029, USA.



To assess the outcomes for patients with Gleason score 8-10 prostate cancer treated with brachytherapy, external beam radiotherapy (EBRT) and hormonal therapy (HT).


In all, 181 patients with Gleason scores 8-10 prostate cancer were treated from 1994 to 2006 with a (103)Pd implant (prescription dose 100 Gy), 45 Gy of EBRT and 9 months of HT. The median (range) follow-up was 65 (24-150) months; freedom from biochemical failure (FBF) rates were calculated using the Phoenix definition.


The 8-year actuarial FBF, freedom from distant metastases, prostate-cancer specific survival and overall survival were 73%, 80%, 87% and 79%, respectively. The pretreatment prostate-specific antigen (PSA) level significantly affected FBF, with 8-year rates of 72%, 82% and 58% for patients with PSA level of <or=10, >10-20 and >20 ng/mL, respectively (P = 0.006). The PSA level had no significant effect on rates of distant metastases. The Gleason score had the most significant affect on FBF in a multivariate analysis, and was the only factor to significantly affect rates of distant metastases; the 8-year FBF rates were 84%, 55% and 30% for scores of 8, 9 and 10, respectively (P = 0.003). The corresponding freedom from distant metastases and prostate-cancer specific survival rates were 86%, 76%, 30% (P < 0.001) and 92%, 80%, 62.5% (P = 0.003), respectively.


The 8-year outcomes after this regimen showed favourable biochemical and distant control, as well disease-specific survival rates for patients with Gleason scores of 8-10. This treatment approach should be considered as a viable option for this subset of patients with high-risk disease.

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