1. Peter Grimm, DO Prostate Cancer Center of Seattle
Comparing Treatment Results Of PROSTATE CANCER
Prostate Cancer Results Study Group 2012
Peter Grimm, DO
Prostate Cancer Center of Seattle
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2. Prostate Cancer Results Study Group
Problem: Patients need a simple means to compare the cancer control rates of modern prostate cancer treatment methods.
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3. Prostate Cancer Results Study Group
To solve this problem, we have assembled experts from key treating disciplines: Surgery, External Radiation, Internal (or Brachytherapy), High Frequency Ultrasound, and Proton Therapy
The purpose of this work is to do a complete review study of the current literature on prostate cancer treatment
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4. Prostate Cancer Results Study Group
Ignace Billiet, MD F.E.B.U., Urologist Kortrijk, Belgium
David Bostwick, MD Bostwick Laboratories
David Crawford, MD Univ Colorado, Denver
Adam Dicker, MD Thomas Jefferson U Philadelphia,PA
Steven Frank, MD MD Andersen, Houston Texas
Peter Grimm, DO Prostate Cancer Center of Seattle
Jos Immerzeel, MD De Prostaat Kliniek Netherlands
Stephen Langley, MD St Luke's Cancer Centre, Guildford England
Alvaro Martinez, MD William Beaumont , Royal Oak, Mi
Mira Keyes, MD BC Cancer Agency , Vancouver Canada
Patrick Kupelian, MD UCLA Med Center Los Angeles
Robert Lee , MD Duke University Medical Center
Stefan Machtens, MD University Bergisch, Gladbach Germany
Jyoti Mayadev, UC Davis Davis ,California
Brian Moran, MD Chicago Prostate Institute Chicago
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5. Prostate Cancer Results Study Group
Gregory Merrick, MD Schiffler Cancer Center Wheeling West Virginia
Jeremy Millar, MD Alfred Health and Monash University, Melbourne Australia
Mack Roach, MD UCSF San Francisco California
Richard Stock, MD Mt. Sinai New York
Katsuto Shinohara, MD UCSF San Francisco California
Mark Scholz, MD Prostate Cancer Research Institute Marina del Ray California
Edward Weber, MD Prostate Cancer Center of Seattle
Anthony Zietman, MD Harvard Joint Center Boston Ma
Michael Zelefsky, MD Memorial Sloan Kettering New York
Jason Wong, MD UC Irvine Irvine California
Stacy Wentworth, MD Piedmont Radiation Oncology Greensboro , NC
Robyn Vera, DO Medical College of Virginia Richmond Virginia
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6. ABOUT THIS REVIEW STUDY
21,000+ prostate studies were published between 2000 and 2011
917 of those studies featured treatment results
145 of those met the criteria to be included in this review study.
Some treatment methods are under-represented due to failure to meet criteria
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7. About This Study
“Will I be cured?” or “Will my treatment make me cancer free?” are valid patient questions. However, PSA numbers (our best measurement tool today) cannot answer this absolutely. The current state-of-the-art can only indicate that the treatment was “successful” if PSA numbers do not indicate cancer progression.
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8. About This Study
After prostate removal, PSA numbers usually fall rapidly to very low numbers and stay low.
After radiation, PSA numbers usually come down slower, might increase then fall in the 1 to 3 year range (called a “PSA Bump”), and then usually level out at a higher number than the surgery patient.
These different PSA expectations result in dissimilar ways to review a man’s PSA history to judge treatment success.
This study makes no attempt to standardize those evaluation systems.
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9. Abbreviations
Brachy = Seed implantation either permanent or temporary seeds
IMRT = Intensity Modulated Radiation Therapy a form of External Radiation
RP = Standard open radical prostatectomy
Robot RP = Robotic Radical Prostatectomy
HIFU = High frequency Ultrasound
Cryo= Cryotherapy
Protons = form of External Radiation using Protons
EBRT= External Beam Radiation Therapy
ADT= Hormone Therapy
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10. Criteria for Inclusion of Article*
Patients should be separated into Low, Intermediate, and High Risk
Success must be determined by PSA analysis
All Treatment types considered: Seeds (Brachy), Surgery (Standard or Robotic), IMRT (Intensity Modulated Radiation), HIFU (High Frequency Ultrasound), CRYO (Cryo Therapy), Protons, HDR (High dose Rate Brachytherapy)
Article must be in a Peer Reviewed Journal
* Expert panel consensus
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11. Criteria for Inclusion of Article (cont.)
5. Low Risk articles must have a minimum of 100 patients
6. Intermediate Risk articles must have a minimum of 100 patients
7. High Risk articles, because of fewer patients, need only 50 patients to meet criteria
8. Patients must have been followed for a median of 5 years
For additional criteria information contact:
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12. % Articles Meeting CriteriaRP
EBRT/IMRT
Cryo
Brachy/HDR
Robot RP
Proton
HIFU
7.4%
10% 6%
19%
3.2%
23% 3%
20/272
26/241
2/32
44/236
2/62
3/13
1/31
Total of 917 Treatment Articles. Some articles addressed several treatments and were counted as separate articles for each treatment.
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13. How to Interpret the Results
Each treatment is given a symbol. For example Seed implant alone (Brachy) is given a blue dot with a number in it.
The number in the symbol refers to the article. The article can be found in the notes section below the slide ( go into “view” in up left corner of PowerPoint and click on note section, then click on this portion and scroll down to see all the references)
Treatment Success % = Percent of men whose PSA numbers do not indicate cancer progression. (progression free) at a specific point in time
The bottom line indicates the number years the study is out An example, the blue dot with 27 inside indicates that, as per article 27, 97% of the patients treated with seeds alone in low risk patients at 12 years were free of disease progression according to PSA numbers 27
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14. How to Interpret the Results
First Establish your clinical risk group* by looking at the definitions or ask your physician Refer only to those slides for your risk group
Make your own judgment and then ask a doctor in each discipline ( Seeds, External Radiation Surgery, etc) to tell you where his/her own peer reviewed published Treatment Success % would fit on this plot.
*Next Slide
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15. LOW Risk Group Definition
Stage: T1 or T2a,b Gleason Sum < PSA < 10 ng/ml
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16. LOW RISK RESULTS % PSA Progression Free Treatment Success23 14 21 25 27 13 8 4 22 37 30 6 35 3 33 32 10 39
103 31 29
101 28
Treatment Success
EBRT &
Seeds 18
105 24 38
102 36 5 16 19 2 26 12 40 1
Robot RP
100 7
104 9 15
CRYO
1st Group References:
Kupelian P, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (RP)
Thames H, et al. Increasing external beam dose for T1-T2 prostate cancer: Effect on risk groups. Int J Radiat Oncol Biol Phys 2006;65(4):
Zelefsky M, et al. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
Martin AG, Roy J, Beaulieu L, et al. Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-Year Canadian experience. Int J Radiat Oncol Biol Phys 2007;67(2):
Potters L, et al.12-Year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urology 2005;173:
Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
Zelefsky M, et al. Long term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urology 2006;176:
Zelefsky M, et al. Five-Year outcome of Intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2007;67(1):65-70.
Boorjian S, et al. Mayo Clinic validation of the D'Amico risk group classification for predicting survival following radical prostatectomy. J Urology 2008;179:
Critz J, et al. 10-Year disease free survival rates after simultaneous irradiation for prostate cancer with a focus on calculation and methodology. J Urology 2004;172:
Kuban D, et al. Long-Term multi-institutional analysis of stage T1-T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys 2003;57(4):
Weight C, et al. Limited pelvic lymph node dissection does not improve biochemical relapse free survival at 10-years after radical prostatectomy in patients with low risk prostate cancer. J Urology 2008;71(1):
Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-Free Survival After Prostate Brachytherapy. J Urol 2005;66(5):
Merrick G, et al. Androgen deprivation therapy does not impact cause-specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2006;65(3):669-67
Rossi C, et al. Conformal proton beam radiation therapy for prostate cancer: concepts and clinical results. Community Oncology 2007;4(4):
Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185:
(Open)
Zelefsky M, et al. Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation in biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008;71(4):
Pickles T, et al. Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A single-Institutional Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2010; 76(1): (EBRT)
Bittner N, et al. Primary causes of death after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2008;72(2):
Morris W, et al. Population-based Study of Biochemical and Survival Outcomes After Permanenet 125I Brachytherapy for Low and Intermediate-risk Prostate Cancer. Urol 2009; 73(4);
Moyad M, et al. Statins, especially Atorvastatin may favorably influence clinical presentation and biochemical PFS after brachytherapy of clinically localized prostate cancer. Urology 2005;66(6):
Bhatta-Dhar N, et al. No difference in 6 year biochemical failure rates with or without pelvic lymph node during radical prostatectomy in low risk patients with prostate cancer. Urology 2004;63(3):
Zietman A, et al. Comparison of conventional dose vs high dose conformal radiation therapy in clinically localized Adenocarcinoma of the prostate. JAMA 2005;294(10): & Correction: JAMA 2008; 299(8):
Nguyen P, et al. Biochemical recurrence after radical prostatectomy for prevalent versus incident cases of prostate cancer. Cancer 2008;113(11):
Taira A, et al. Natural history of clinically staged low- and intermediate risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes J, et al. Excellent results from high dose rate brachytherapy and external beam for prostate cancer are not improved by Androgen deprivation. Amer J Clin Oncol 2009;32(4):
Stone N, et al. Local control following permanent prostate brachytherapy: Effect of high biologically effective dose on biopsy results and oncologic outcomes. Int J Radiat Oncol Biol Phys 2010;76(2):
Pickles T, et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single-istitution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Protons)
Zeitman A, et al. Randomized trial comparing conventional dose with high dose conformal radiation therapy in early-stage Adenocarcinoma of the prostate: Long term results from proton radiation oncology group/American College of Radiology J Clin Oncol 2010;28(7):
Menon M, et al. Biochemical recurrence following robot-assisted radical prostatectomy: Analysis of 1384 patients with a median 5-year follow-up. Eur Urol. 2010;58:
Kane CJ, et al. Outcomes after radical prostatectomy among men who are candidates for active surveillance: Results from the SEARCH database urology. Urol 2010;76(3):
Ellis R, et al. Ten year outcomes : The clinical utility of single photon emission computed tomography/computed tomography capromab pendetide (prostascint) in a cohort diagnosed with localized prostate cancer. Int J Radiat Oncol Biol Phys 2011; 81(1): Epub date:
Hinnen, K. et al. Long term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (Seeds)
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (IMRT 81Gy)
Burri, R. et al. Young Men Have Equivalent Biochemical outcomes Compared With Older Men After Treatment With Brachytherapy For Prostate Cancer. Int J Radiat Oncol Biol Phys 2010; 77(5):
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
100. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (Seeds)
101. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (EBRT)
102. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Brachy)
103. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Protons)
105. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ;
104. Sylvester, J, Grimm P et at Fifteen Year Biochemical RFS CSS, OS Following I-125 Prostate Brachytherapy in Clinically localized prostate cancer Int J Radiat Oncol Biol Phys 2011;81;376-81:
HIFU 34
Protons
← Years from Treatment →
HDR 11
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp. 1)
Prostate Cancer Center of Seattle

17. LOW RISK RESULTS Brachy % PSA Progression Free EBRT Surgery Weighted23 14 21
EBRT 25 27 13 8 4 22 37 30 6 35 3 33 32 10 39
103 31 29
101 28 18
EBRT & Seeds
105 24 38
102 36 5 16 19 2 26 12 40 1
100
Robot RP 7
104 9
Treatment Success 15
Surgery
CRYO
1st Group References:
Kupelian P, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (RP)
Thames H, et al. Increasing external beam dose for T1-T2 prostate cancer: Effect on risk groups. Int J Radiat Oncol Biol Phys 2006;65(4):
Zelefsky M, et al. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
Martin AG, Roy J, Beaulieu L, et al. Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-Year Canadian experience. Int J Radiat Oncol Biol Phys 2007;67(2):
Potters L, et al.12-Year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urology 2005;173:
Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
Zelefsky M, et al. Long term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urology 2006;176:
Zelefsky M, et al. Five-Year outcome of Intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2007;67(1):65-70.
Boorjian S, et al. Mayo Clinic validation of the D'Amico risk group classification for predicting survival following radical prostatectomy. J Urology 2008;179:
Critz J, et al. 10-Year disease free survival rates after simultaneous irradiation for prostate cancer with a focus on calculation and methodology. J Urology 2004;172:
Kuban D, et al. Long-Term multi-institutional analysis of stage T1-T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys 2003;57(4):
Weight C, et al. Limited pelvic lymph node dissection does not improve biochemical relapse free survival at 10-years after radical prostatectomy in patients with low risk prostate cancer. J Urology 2008;71(1):
Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-Free Survival After Prostate Brachytherapy. J Urol 2005;66(5):
Merrick G, et al. Androgen deprivation therapy does not impact cause-specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2006;65(3):669-67
Rossi C, et al. Conformal proton beam radiation therapy for prostate cancer: concepts and clinical results. Community Oncology 2007;4(4):
Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185:
(Open)
Zelefsky M, et al. Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation in biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008;71(4):
Pickles T, et al. Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A single-Institutional Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2010; 76(1): (EBRT)
Bittner N, et al. Primary causes of death after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2008;72(2):
Morris W, et al. Population-based Study of Biochemical and Survival Outcomes After Permanenet 125I Brachytherapy for Low and Intermediate-risk Prostate Cancer. Urol 2009; 73(4);
Moyad M, et al. Statins, especially Atorvastatin may favorably influence clinical presentation and biochemical PFS after brachytherapy of clinically localized prostate cancer. Urology 2005;66(6):
Bhatta-Dhar N, et al. No difference in 6 year biochemical failure rates with or without pelvic lymph node during radical prostatectomy in low risk patients with prostate cancer. Urology 2004;63(3):
Zietman A, et al. Comparison of conventional dose vs high dose conformal radiation therapy in clinically localized Adenocarcinoma of the prostate. JAMA 2005;294(10): & Correction: JAMA 2008; 299(8):
Nguyen P, et al. Biochemical recurrence after radical prostatectomy for prevalent versus incident cases of prostate cancer. Cancer 2008;113(11):
Taira A, et al. Natural history of clinically staged low- and intermediate risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes J, et al. Excellent results from high dose rate brachytherapy and external beam for prostate cancer are not improved by Androgen deprivation. Amer J Clin Oncol 2009;32(4):
Stone N, et al. Local control following permanent prostate brachytherapy: Effect of high biologically effective dose on biopsy results and oncologic outcomes. Int J Radiat Oncol Biol Phys 2010;76(2):
Pickles T, et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single-istitution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Protons)
Zeitman A, et al. Randomized trial comparing conventional dose with high dose conformal radiation therapy in early-stage Adenocarcinoma of the prostate: Long term results from proton radiation oncology group/American College of Radiology J Clin Oncol 2010;28(7):
Menon M, et al. Biochemical recurrence following robot-assisted radical prostatectomy: Analysis of 1384 patients with a median 5-year follow-up. Eur Urol. 2010;58:
Kane CJ, et al. Outcomes after radical prostatectomy among men who are candidates for active surveillance: Results from the SEARCH database urology. Urol 2010;76(3):
Ellis R, et al. Ten year outcomes : The clinical utility of single photon emission computed tomography/computed tomography capromab pendetide (prostascint) in a cohort diagnosed with localized prostate cancer. Int J Radiat Oncol Biol Phys 2011; 81(1): Epub date:
Hinnen, K. et al. Long term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (Seeds)
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (IMRT 81Gy)
Burri, R. et al. Young Men Have Equivalent Biochemical outcomes Compared With Older Men After Treatment With Brachytherapy For Prostate Cancer. Int J Radiat Oncol Biol Phys 2010; 77(5):
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
100. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (Seeds)
101. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (EBRT)
102. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Brachy)
103. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Protons)
105. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ;
104. Sylvester, J, Grimm P et at Fifteen Year Biochemical RFS CSS, OS Following I-125 Prostate Brachytherapy in Clinically localized prostate cancer Int J Radiat Oncol Biol Phys 2011;81;376-81:
HIFU 34
Protons
← Years from Treatment →
HDR 11
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp. 1)
Prostate Cancer Center of Seattle

18. Question about the Criteria
“The PCRSG criteria is pretty strict and not a lot of studies fit. What happens if you include articles with only 40 months of follow up or have a long follow up but less than 100 patients?”
3/24/2017

19. >40 months follow-up or less than 100 patients
LOW RISK RESULTS
>40 months follow-up or less than 100 patients
% PSA Progression Free 68 51 50 46 97 96 23 14 21
Seeds & ADT 66 25 27 + 22 13 8 48 4 75 62 37 81 6 44 86 35 30 82 3 60
EBRT & ADT 69 41 71 33 32 10 98 65 85 39
Treatment Success
103 84 31 72 29
101 28 67 89 42 94 95 61 93 18 88
EBRT & Seeds
105 24 38 73 54
102 36 5 16 19 47 78 43 2 26 12 64 55 52 40 83 58 1
Robot RP
100 87 76 56 7
104 77 9 70 80 41 15 45 57 74 79 59 53 90
CRYO
1st Group References:
Kupelian P, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (RP)
Thames H, et al. Increasing external beam dose for T1-T2 prostate cancer: Effect on risk groups. Int J Radiat Oncol Biol Phys 2006;65(4):
Zelefsky M, et al. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
Martin AG, Roy J, Beaulieu L, et al. Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-Year Canadian experience. Int J Radiat Oncol Biol Phys 2007;67(2):
Potters L, et al.12-Year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urology 2005;173:
Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
Zelefsky M, et al. Long term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urology 2006;176:
Zelefsky M, et al. Five-Year outcome of Intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2007;67(1):65-70.
Boorjian S, et al. Mayo Clinic validation of the D'Amico risk group classification for predicting survival following radical prostatectomy. J Urology 2008;179:
Critz J, et al. 10-Year disease free survival rates after simultaneous irradiation for prostate cancer with a focus on calculation and methodology. J Urology 2004;172:
Kuban D, et al. Long-Term multi-institutional analysis of stage T1-T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys 2003;57(4):
Weight C, et al. Limited pelvic lymph node dissection does not improve biochemical relapse free survival at 10-years after radical prostatectomy in patients with low risk prostate cancer. J Urology 2008;71(1):
Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-Free Survival After Prostate Brachytherapy. J Urol 2005;66(5):
Merrick G, et al. Androgen deprivation therapy does not impact cause-specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2006;65(3):669-67
Rossi C, et al. Conformal proton beam radiation therapy for prostate cancer: concepts and clinical results. Community Oncology 2007;4(4):
Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185:
(Open)
Zelefsky M, et al. Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation in biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008;71(4):
Pickles T, et al. Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A single-Institutional Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2010; 76(1): (EBRT)
Bittner N, et al. Primary causes of death after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2008;72(2):
Morris W, et al. Population-based Study of Biochemical and Survival Outcomes After Permanenet 125I Brachytherapy for Low and Intermediate-risk Prostate Cancer. Urol 2009; 73(4);
Moyad M, et al. Statins, especially Atorvastatin may favorably influence clinical presentation and biochemical PFS after brachytherapy of clinically localized prostate cancer. Urology 2005;66(6):
Bhatta-Dhar N, et al. No difference in 6 year biochemical failure rates with or without pelvic lymph node during radical prostatectomy in low risk patients with prostate cancer. Urology 2004;63(3):
Zietman A, et al. Comparison of conventional dose vs high dose conformal radiation therapy in clinically localized Adenocarcinoma of the prostate. JAMA 2005;294(10): & Correction: JAMA 2008; 299(8):
Nguyen P, et al. Biochemical recurrence after radical prostatectomy for prevalent versus incident cases of prostate cancer. Cancer 2008;113(11):
Taira A, et al. Natural history of clinically staged low- and intermediate risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes J, et al. Excellent results from high dose rate brachytherapy and external beam for prostate cancer are not improved by Androgen deprivation. Amer J Clin Oncol 2009;32(4):
Stone N, et al. Local control following permanent prostate brachytherapy: Effect of high biologically effective dose on biopsy results and oncologic outcomes. Int J Radiat Oncol Biol Phys 2010;76(2):
Pickles T, et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single-istitution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Protons)
Zeitman A, et al. Randomized trial comparing conventional dose with high dose conformal radiation therapy in early-stage Adenocarcinoma of the prostate: Long term results from proton radiation oncology group/American College of Radiology J Clin Oncol 2010;28(7):
Menon M, et al. Biochemical recurrence following robot-assisted radical prostatectomy: Analysis of 1384 patients with a median 5-year follow-up. Eur Urol. 2010;58:
Kane CJ, et al. Outcomes after radical prostatectomy among men who are candidates for active surveillance: Results from the SEARCH database urology. Urol 2010;76(3):
Ellis R, et al. Ten year outcomes : The clinical utility of single photon emission computed tomography/computed tomography capromab pendetide (prostascint) in a cohort diagnosed with localized prostate cancer. Int J Radiat Oncol Biol Phys 2011; 81(1): Epub date:
Hinnen, K. et al. Long term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (Seeds)
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (IMRT 81Gy)
Burri, R. et al. Young Men Have Equivalent Biochemical outcomes Compared With Older Men After Treatment With Brachytherapy For Prostate Cancer. Int J Radiat Oncol Biol Phys 2010; 77(5):
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
100. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (Seeds)
101. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (EBRT)
102. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Brachy)
103. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Protons)
105. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ;
104. Sylvester, J, Grimm P et at Fifteen Year Biochemical RFS CSS, OS Following I-125 Prostate Brachytherapy in Clinically localized prostate cancer Int J Radiat Oncol Biol Phys 2011;81;376-81:
2nd Group References:
Blasko J, et al. Palladium-103 brachytherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 2000;46(4):
Demanes D, et al. High-Dose-Rate Intensity-Modulated Brachytherapy with External Beam Radiotherapy for Prostate Cancer: California Endocurietherapy;s 10-Year results. Int J Radiat Oncol Bio Phys 2005;61(5):
Grimm P, et al. 10-year biochemical (prostate-specific antigen) control of prostate cancer with I-125 brachytherapy. Int J Radiat Oncol Biol Phys 2001;51(1):31-40.
Hernandez D, et al. Contemporary evaluation of the D'Amico risk classification of prostate cancer. J Urol 2007; 70(5):
Kupelian P, et al.Improved Biochemical relapse-free survuval with increased external radiation doses in patients with localized prostate cancer: the combined experience of nine institutions in patients treated in 1994 and Int J Radiat Oncol Biol Phys 2005;61(2):
Merrick G, et al. Impact of supplemental external beam radiotherapy and/or androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005;61(1):
Vora S, et al. Analysis of biochemical control and prognostic factors in patients treated with either low-dose three-dimensional conformal radiation therapy or high-dose intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Bio Phys 2007;68(4):
Merrick G, et al. Brachytherapy inmen aged <54 years with clinically localized prostate cancer. BJU Int 2006;98:
Bahn D, et al. Targeted cryoablation of the prostate: 7 year outcome in the primary treatment of prostate cancer. Urol 2002;60(Supp 2A):3-11.
Phan T, et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. J Urol 2007;177:
Cahlon O, et al. Ultra high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Biol Phys 2008;71(2):
Sylvester J, et al. 15-Year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys 2007;67(1):57-64.
Higgins G, et al. Outcome analysis of 300 prostate cancer patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy. Int J Radiat Oncol Biol Phys 2006;65(4):
Kollmeier M, et al. Biochemical outcomes after prostate brachytherapy with 5-year minimal follow-up: importance of patient selection and implant quality. Int J Radiat Oncol Biol Phys 2003;57(3):
Stone N, et al. Customized dose prescription for permanent prostate brachytherapy: Insights from a multicenter analysis of dosimetry outcomes. Int J Radiat Oncol Biol Phys 2007;69(5):
Beyer D, et al. Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. Brachytherapy 2003;2:77-84.
Ellis R, et al. Biochemical disease-free survival rates following definitive low-dose rate prostate brachytherapy with dose escalation to biologic target volumes identified with SPECT/CT capromab pendetide. Brachytherapy 2007;6:16-25.
Kwok Y, et al. Risk group stratification in patients undergoing permanent I-125 prostate brachytherapy as monotherapy. Int J Radiat Oncol Biol Phys 2002;53(3):
Blana A, et al. Eight years’ experience with high-intensity focused ultrasonography for treatment of localized prostate cancer. J Urol 2008;72(6):
Lawton, C et al. Long-term Results of a Phase II Trial of Ultrasound-Guided Radioactive Implantation of the Prostate for Definitive Management of Localized Adenocarcinoma of the Prostate (RTOG ) Int J Radiat Oncol Bio Phys 2011;81(1):1-7.
Zelefsky M, et al. High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 2001;166: (81Gy)
Khuntia D, et al. Recurrence free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in prostate-specific antigen era. Cancer 2004;100(6):
Blana A, et al. First Analysis of the Long-Term results with Transrectal HIFU in Patients with Localised prostate Cancer. Eurr Urology 2008;53:
Henry A, et al. Outcomes following Iodine-125 monotherapy for localized prostate cancer: the results of Leeds 10-year single-center brachytherapy experience. Int J Radiat Oncol Biol Phys 2010;76(1):50-56.
Aizer A, et al. Radical prostatectomy vs. intensity-modulated radiation therapy in the management of localized prostate adenocarcinoma. Radiotherapy and Oncology 2009; 93:
Gómez-Iturriaga Piña A, et al. Median 5 year Follow-up of I-125 Brachytherapy as Monotherapy in Men aged <55 Years with Favorable Prostate Cancer. J Urology 2010;75(6): & Gómez-Iturriaga Piña A, et al. Biochemical Disease-free rate toxicicty for Men treated with I-125 prostate Brachytherapy with D90> 180GY. Int J Radia Oncol Bio Phys 2010;78(2):
Prada P, et al. Prostate-specific antigen relapse-free survival and side effects in 734 patients with up to 10 years of follow-up with localized prostate cancer treated by permanent Iodine-125 implants. BJU Int 2010;106(1):32-36.
Rene N, et al. Hypofractionated radiotherapy for favorable risk prostate cancer. Int J Radiat Oncol Biol Phys 2010;77(3):
Lawton C, et al. Results of a Phase II Trial of Transrectal Ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (radiation therapy oncology group 98-05). Int J Radiat Oncol Bio Phys 2007;67(1):39-47.
Deger S, et al. High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer. Eurr Urology 2005;47(4):
Colberg J, et al. Surgery versus implant for early prostate cancer: results from a single institution, Cancer J 2007;13(4): (RP)
Colberg J, et al. Surgery versus implant for early prostate cancer: results from a single institution, Cancer J 2007;13(4): (Seeds)
D’Amico A, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002;95(2): (RP)
D’Amico A, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002;95(2): (EBRT)
Block T, et al. Transperineal permanent seed implantation of “low-risk” prostate cancer. Strahlentherapie und Onkologie 2006;182:
Battermann J, et al. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiotherapy & Oncology 2004;71:23-28.
Livsey J, et al. Hypofractionated conformal radiotherapy in carcinoma of the prostate: five-year outcome analysis. Int J Radiat Oncol Biol Phys 2003;57(5):
Lederman G.S, et al. Retrospective stratification of a consecutive cohort of prostate cancer patients treated with a combined regimen of external-beam radiotherapy and brachytherapy. Int J Radiat Oncol Biol Phys 2001; 49(5):
Kuban D, et al. Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008;70(1): (78Gy)
Berglund R, et al. Limited pelvic lymph node dissection at the time of radical prostatectomy does not affect 5-year failure rates for low, intermediate and high risk prostate cancer: results from CaPSURE. J Urology 2007;177:
Khaksar S, et al. Interstitial low dose rate brachytherapy for prostate cancer- A focus on intermediate- and high-risk disease. Clinical Oncology 2006;18:
Hull G, et al. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urology 2002;167:
Sylvester J, et al. Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: The Seattle experience. Int J Radiat Oncol Biol Phys 2003;57(4)
Giberti C, et al. Radial retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study. World J Urol 2009;27: (RP)
Giberti C, et al. Radial retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study. World J Urol 2009;27: (Seeds)
Kupelian P, et al. Hypofractionated intersity-modulated radiotherapy (70 GY at 2.5GY per fraction) for localized prostate cancer: Cleveland clinic experience. Int J Radiat Oncol Biol Phys 2007;68(5):
Kupelian P, et al. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: A large scale single institution experience with radical prostatectomy and external-beam radiotherapy. J Clinical Oncology 2002;20(16): (RP)
Kupelian P, et al. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: A large scale single institution experience with radical prostatectomy and external-beam radiotherapy. J Clinical Oncology 2002;20(16): (EBRT)
Peschel R, et al. Iodine 125 versus palladium 103 implants for prostate cancer: Clinical outcomes and complications. The Cancer Journal 2004;10(3):
Crouzet S, et al. Multicentric Oncologic Outcomes of High Intensity Focused Ultrasound for Localized Prostate Cancer in 803 patients. Eurr Urol 2010;58:
Misraї V, et al. Oncologic control provided by HIFU therapy as single treatment in men with localized prostate cancer. World J Urol 2008;26:
Nobes JP, et al. Biochemical relapse-free survival in 400 patients treated with I-125 prostate brachytherapy: the Guildford experience. Prostate Cancer & Prostatic Disease 2009;12: (Seeds)
Nobes JP, et al. Biochemical relapse-free survival in 400 patients treated with I-125 prostate brachytherapy: the Guildford experience. Prostate Cancer & Prostatic Disease 2009;12: (Seeds & ADT)
Shapiro E, et al. Long-Term outcomes in younger men following permanent prostate brachytherapy. J Urol 2009;181: (<60 yrs old)
Shapiro E, et al. Long-Term outcomes in younger men following permanent prostate brachytherapy. J Urol 2009;181: (>60 yrs old)
96. Crook, J et al. 10-Year Experience with I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients. Int J Radiat Oncol Bio Phys 2011;80(5):
97. Goldner, G et al. Comparison of seed brachytherapy or external beam radiotherapy (70Gy or 74Gy) in 919 low-risk prostate cancer patients. Stathentherapie und Onkol 2012;4: (Brachy)
98. Goldner, G et al. Comparison of seed brachytherapy or external beam radiotherapy (70Gy or 74Gy) in 919 low-risk prostate cancer patients. Stathentherapie und Onkol 2012;4: (EBRT) 63
HIFU 34
Protons
← Years from Treatment →
Hypo EBRT 91 49 11
HDR
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

20. LOW RISK RESULTS Weighted
>40 months follow-up or less than 100 patients
EBRT
Brachy
% PSA Progression Free 68 51 50 46 97 92 96 23 14 21
Seeds & ADT 66 25 27 + 22 13 8 48 4 75 62 37 81 6 44 86 35 30 82 3 60
EBRT & ADT 69 41 71 33 32 10 65 85 39
Treatment Success
103 98 84 31 72 29
101 28 67 89 42 94 95 61 93 18 88
EBRT & Seeds
105 24 38 73 54
102 36 5 16 19 47 78 43 2 26 12 64 55 52 40 83 58 1
Robot RP
100 87 76 56 7
104 77 9 70 80 41 15 45 57 74 79 59
Surgery 53 90
CRYO
1st Group References:
Kupelian P, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (RP)
Thames H, et al. Increasing external beam dose for T1-T2 prostate cancer: Effect on risk groups. Int J Radiat Oncol Biol Phys 2006;65(4):
Zelefsky M, et al. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
Martin AG, Roy J, Beaulieu L, et al. Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-Year Canadian experience. Int J Radiat Oncol Biol Phys 2007;67(2):
Potters L, et al.12-Year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urology 2005;173:
Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
Zelefsky M, et al. Long term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urology 2006;176:
Zelefsky M, et al. Five-Year outcome of Intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2007;67(1):65-70.
Boorjian S, et al. Mayo Clinic validation of the D'Amico risk group classification for predicting survival following radical prostatectomy. J Urology 2008;179:
Critz J, et al. 10-Year disease free survival rates after simultaneous irradiation for prostate cancer with a focus on calculation and methodology. J Urology 2004;172:
Kuban D, et al. Long-Term multi-institutional analysis of stage T1-T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys 2003;57(4):
Weight C, et al. Limited pelvic lymph node dissection does not improve biochemical relapse free survival at 10-years after radical prostatectomy in patients with low risk prostate cancer. J Urology 2008;71(1):
Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-Free Survival After Prostate Brachytherapy. J Urol 2005;66(5):
Merrick G, et al. Androgen deprivation therapy does not impact cause-specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2006;65(3):669-67
Rossi C, et al. Conformal proton beam radiation therapy for prostate cancer: concepts and clinical results. Community Oncology 2007;4(4):
Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185:
(Open)
Zelefsky M, et al. Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation in biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008;71(4):
Pickles T, et al. Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A single-Institutional Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2010; 76(1): (EBRT)
Bittner N, et al. Primary causes of death after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2008;72(2):
Morris W, et al. Population-based Study of Biochemical and Survival Outcomes After Permanenet 125I Brachytherapy for Low and Intermediate-risk Prostate Cancer. Urol 2009; 73(4);
Moyad M, et al. Statins, especially Atorvastatin may favorably influence clinical presentation and biochemical PFS after brachytherapy of clinically localized prostate cancer. Urology 2005;66(6):
Bhatta-Dhar N, et al. No difference in 6 year biochemical failure rates with or without pelvic lymph node during radical prostatectomy in low risk patients with prostate cancer. Urology 2004;63(3):
Zietman A, et al. Comparison of conventional dose vs high dose conformal radiation therapy in clinically localized Adenocarcinoma of the prostate. JAMA 2005;294(10): & Correction: JAMA 2008; 299(8):
Nguyen P, et al. Biochemical recurrence after radical prostatectomy for prevalent versus incident cases of prostate cancer. Cancer 2008;113(11):
Taira A, et al. Natural history of clinically staged low- and intermediate risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes J, et al. Excellent results from high dose rate brachytherapy and external beam for prostate cancer are not improved by Androgen deprivation. Amer J Clin Oncol 2009;32(4):
Stone N, et al. Local control following permanent prostate brachytherapy: Effect of high biologically effective dose on biopsy results and oncologic outcomes. Int J Radiat Oncol Biol Phys 2010;76(2):
Pickles T, et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single-istitution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Protons)
Zeitman A, et al. Randomized trial comparing conventional dose with high dose conformal radiation therapy in early-stage Adenocarcinoma of the prostate: Long term results from proton radiation oncology group/American College of Radiology J Clin Oncol 2010;28(7):
Menon M, et al. Biochemical recurrence following robot-assisted radical prostatectomy: Analysis of 1384 patients with a median 5-year follow-up. Eur Urol. 2010;58:
Kane CJ, et al. Outcomes after radical prostatectomy among men who are candidates for active surveillance: Results from the SEARCH database urology. Urol 2010;76(3):
Ellis R, et al. Ten year outcomes : The clinical utility of single photon emission computed tomography/computed tomography capromab pendetide (prostascint) in a cohort diagnosed with localized prostate cancer. Int J Radiat Oncol Biol Phys 2011; 81(1): Epub date:
Hinnen, K. et al. Long term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (Seeds)
Zelefsky et al. Comparison of Tumor Control and toxicity Outcomes of IMRT and Brachytherapy for Patients with Favorable Risk PCa J Urology 2011; 77(4): Epub date: (IMRT 81Gy)
Burri, R. et al. Young Men Have Equivalent Biochemical outcomes Compared With Older Men After Treatment With Brachytherapy For Prostate Cancer. Int J Radiat Oncol Biol Phys 2010; 77(5):
Jabbari S, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys 2010;76(1): (Seeds)
100. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (Seeds)
101. Kupelian P, Kuban D, Thames H, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:(1): (EBRT)
102. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Brachy)
103. Coen, J et al. Comparison of High-Dose-Rate Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Int J Radiat Oncol Biol Phys 2012;81(1):e25-e31. (Protons)
105. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ;
104. Sylvester, J, Grimm P et at Fifteen Year Biochemical RFS CSS, OS Following I-125 Prostate Brachytherapy in Clinically localized prostate cancer Int J Radiat Oncol Biol Phys 2011;81;376-81:
2nd Group References:
Blasko J, et al. Palladium-103 brachytherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 2000;46(4):
Demanes D, et al. High-Dose-Rate Intensity-Modulated Brachytherapy with External Beam Radiotherapy for Prostate Cancer: California Endocurietherapy;s 10-Year results. Int J Radiat Oncol Bio Phys 2005;61(5):
Grimm P, et al. 10-year biochemical (prostate-specific antigen) control of prostate cancer with I-125 brachytherapy. Int J Radiat Oncol Biol Phys 2001;51(1):31-40.
Hernandez D, et al. Contemporary evaluation of the D'Amico risk classification of prostate cancer. J Urol 2007; 70(5):
Kupelian P, et al.Improved Biochemical relapse-free survuval with increased external radiation doses in patients with localized prostate cancer: the combined experience of nine institutions in patients treated in 1994 and Int J Radiat Oncol Biol Phys 2005;61(2):
Merrick G, et al. Impact of supplemental external beam radiotherapy and/or androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005;61(1):
Vora S, et al. Analysis of biochemical control and prognostic factors in patients treated with either low-dose three-dimensional conformal radiation therapy or high-dose intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Bio Phys 2007;68(4):
Merrick G, et al. Brachytherapy inmen aged <54 years with clinically localized prostate cancer. BJU Int 2006;98:
Bahn D, et al. Targeted cryoablation of the prostate: 7 year outcome in the primary treatment of prostate cancer. Urol 2002;60(Supp 2A):3-11.
Phan T, et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. J Urol 2007;177:
Cahlon O, et al. Ultra high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Biol Phys 2008;71(2):
Sylvester J, et al. 15-Year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys 2007;67(1):57-64.
Higgins G, et al. Outcome analysis of 300 prostate cancer patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy. Int J Radiat Oncol Biol Phys 2006;65(4):
Kollmeier M, et al. Biochemical outcomes after prostate brachytherapy with 5-year minimal follow-up: importance of patient selection and implant quality. Int J Radiat Oncol Biol Phys 2003;57(3):
Stone N, et al. Customized dose prescription for permanent prostate brachytherapy: Insights from a multicenter analysis of dosimetry outcomes. Int J Radiat Oncol Biol Phys 2007;69(5):
Beyer D, et al. Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. Brachytherapy 2003;2:77-84.
Ellis R, et al. Biochemical disease-free survival rates following definitive low-dose rate prostate brachytherapy with dose escalation to biologic target volumes identified with SPECT/CT capromab pendetide. Brachytherapy 2007;6:16-25.
Kwok Y, et al. Risk group stratification in patients undergoing permanent I-125 prostate brachytherapy as monotherapy. Int J Radiat Oncol Biol Phys 2002;53(3):
Blana A, et al. Eight years’ experience with high-intensity focused ultrasonography for treatment of localized prostate cancer. J Urol 2008;72(6):
Lawton, C et al. Long-term Results of a Phase II Trial of Ultrasound-Guided Radioactive Implantation of the Prostate for Definitive Management of Localized Adenocarcinoma of the Prostate (RTOG ) Int J Radiat Oncol Bio Phys 2011;81(1):1-7.
Zelefsky M, et al. High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 2001;166: (81Gy)
Khuntia D, et al. Recurrence free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in prostate-specific antigen era. Cancer 2004;100(6):
Blana A, et al. First Analysis of the Long-Term results with Transrectal HIFU in Patients with Localised prostate Cancer. Eurr Urology 2008;53:
Henry A, et al. Outcomes following Iodine-125 monotherapy for localized prostate cancer: the results of Leeds 10-year single-center brachytherapy experience. Int J Radiat Oncol Biol Phys 2010;76(1):50-56.
Aizer A, et al. Radical prostatectomy vs. intensity-modulated radiation therapy in the management of localized prostate adenocarcinoma. Radiotherapy and Oncology 2009; 93:
Gómez-Iturriaga Piña A, et al. Median 5 year Follow-up of I-125 Brachytherapy as Monotherapy in Men aged <55 Years with Favorable Prostate Cancer. J Urology 2010;75(6): & Gómez-Iturriaga Piña A, et al. Biochemical Disease-free rate toxicicty for Men treated with I-125 prostate Brachytherapy with D90> 180GY. Int J Radia Oncol Bio Phys 2010;78(2):
Prada P, et al. Prostate-specific antigen relapse-free survival and side effects in 734 patients with up to 10 years of follow-up with localized prostate cancer treated by permanent Iodine-125 implants. BJU Int 2010;106(1):32-36.
Rene N, et al. Hypofractionated radiotherapy for favorable risk prostate cancer. Int J Radiat Oncol Biol Phys 2010;77(3):
Lawton C, et al. Results of a Phase II Trial of Transrectal Ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (radiation therapy oncology group 98-05). Int J Radiat Oncol Bio Phys 2007;67(1):39-47.
Deger S, et al. High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer. Eurr Urology 2005;47(4):
Colberg J, et al. Surgery versus implant for early prostate cancer: results from a single institution, Cancer J 2007;13(4): (RP)
Colberg J, et al. Surgery versus implant for early prostate cancer: results from a single institution, Cancer J 2007;13(4): (Seeds)
D’Amico A, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002;95(2): (RP)
D’Amico A, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002;95(2): (EBRT)
Block T, et al. Transperineal permanent seed implantation of “low-risk” prostate cancer. Strahlentherapie und Onkologie 2006;182:
Battermann J, et al. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiotherapy & Oncology 2004;71:23-28.
Livsey J, et al. Hypofractionated conformal radiotherapy in carcinoma of the prostate: five-year outcome analysis. Int J Radiat Oncol Biol Phys 2003;57(5):
Lederman G.S, et al. Retrospective stratification of a consecutive cohort of prostate cancer patients treated with a combined regimen of external-beam radiotherapy and brachytherapy. Int J Radiat Oncol Biol Phys 2001; 49(5):
Kuban D, et al. Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008;70(1): (78Gy)
Berglund R, et al. Limited pelvic lymph node dissection at the time of radical prostatectomy does not affect 5-year failure rates for low, intermediate and high risk prostate cancer: results from CaPSURE. J Urology 2007;177:
Khaksar S, et al. Interstitial low dose rate brachytherapy for prostate cancer- A focus on intermediate- and high-risk disease. Clinical Oncology 2006;18:
Hull G, et al. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urology 2002;167:
Sylvester J, et al. Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: The Seattle experience. Int J Radiat Oncol Biol Phys 2003;57(4)
Giberti C, et al. Radial retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study. World J Urol 2009;27: (RP)
Giberti C, et al. Radial retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study. World J Urol 2009;27: (Seeds)
Kupelian P, et al. Hypofractionated intersity-modulated radiotherapy (70 GY at 2.5GY per fraction) for localized prostate cancer: Cleveland clinic experience. Int J Radiat Oncol Biol Phys 2007;68(5):
Kupelian P, et al. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: A large scale single institution experience with radical prostatectomy and external-beam radiotherapy. J Clinical Oncology 2002;20(16): (RP)
Kupelian P, et al. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: A large scale single institution experience with radical prostatectomy and external-beam radiotherapy. J Clinical Oncology 2002;20(16): (EBRT)
Peschel R, et al. Iodine 125 versus palladium 103 implants for prostate cancer: Clinical outcomes and complications. The Cancer Journal 2004;10(3):
Crouzet S, et al. Multicentric Oncologic Outcomes of High Intensity Focused Ultrasound for Localized Prostate Cancer in 803 patients. Eurr Urol 2010;58:
Misraї V, et al. Oncologic control provided by HIFU therapy as single treatment in men with localized prostate cancer. World J Urol 2008;26:
Nobes JP, et al. Biochemical relapse-free survival in 400 patients treated with I-125 prostate brachytherapy: the Guildford experience. Prostate Cancer & Prostatic Disease 2009;12: (Seeds)
Nobes JP, et al. Biochemical relapse-free survival in 400 patients treated with I-125 prostate brachytherapy: the Guildford experience. Prostate Cancer & Prostatic Disease 2009;12: (Seeds & ADT)
Shapiro E, et al. Long-Term outcomes in younger men following permanent prostate brachytherapy. J Urol 2009;181: (<60 yrs old)
Shapiro E, et al. Long-Term outcomes in younger men following permanent prostate brachytherapy. J Urol 2009;181: (>60 yrs old)
96. Crook, J et al. 10-Year Experience with I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients. Int J Radiat Oncol Bio Phys 2011;80(5):
98. Goldner, G et al. Comparison of seed brachytherapy or external beam radiotherapy (70Gy or 74Gy) in 919 low-risk prostate cancer patients. Stathentherapie und Onkol 2012;4: (EBRT)
97. Goldner, G et al. Comparison of seed brachytherapy or external beam radiotherapy (70Gy or 74Gy) in 919 low-risk prostate cancer patients. Stathentherapie und Onkol 2012;4: (Brachy) 63
HIFU 34
Protons
← Years from Treatment →
Hypo EBRT 91 49 11
HDR
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

21. Intermediate Risk Patient Definition
Zelefsky definition
Only 1 factor
Clinical Stage T2c
Gleason score > 7
PSA > 10 ng/ml
D’Amico definition
PSA Gleason Score 7 or Stage T2b
3/24/2017

22. INTERMEDIATE RISK RESULTS
% PSA Progression Free 33 24 23 13
Robot RP 14 37 35 34
Seeds + ADT 44 +
Treatment Success 15 40 16 4 36 38 32
EBRT & Seeds 30 45 39 6 12 42
Hypo EBRT 3 43 47 17 27 18
Seeds Alone 5 26 28 19 9 7 25 41 29 1 2 10 8 11 46
1st Group References:
Bahn, D et al. Targeted Cryo-Ablation of the Prostate:7 yr Outcomes in Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
3 Critz, F et al. 10-Year Disease Free Survival Rates after Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation and Methodology. J Urology 2004;172:
4 Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal high Dose Brachytherapy Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
5 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (RP)
6 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (Seeds)
7 Kupelian, P et al. Imporved biochemial Relapse-Free Survival With Increased External Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in patients in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
8 Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Bio Phys 2003;57(4):
9 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT)
10 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (RP)
11 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (Seeds)
12 Martin, A et al. Permanent Prostate Implant Using High activity Seeds and Inverse Planning with Fast simulated annealing Algorithm: 12 Year Canadian Experience Int J Radiat Oncol Bio Phys 2007;67(2):
13 Merrick G, et al. Androgen Deprivation Therapy Dose not Impact Cause Specific Overall Survival after Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3):
14 Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. J Urology 2005;66(5):
15 Phan, T, et al. High Dose Rate Brachytherapy as a Boost for the Treatment of Localized Prostate Cancer. J Urology 2002;177:
16 Burri, R et al. Young Men Have Equivalent Biochmical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer Int J Radiat Oncol Bio Phys 2010; 77(5):
17 Potters, L et al. 12 year Outcomes Following Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer J Urol 2005;173:
18 Rossi, C et al. Conformal Proton Beam Radiation Therapy for Prostate Cancer: Concepts & Clinical Results. Comm Oncol 2007;4:
19 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (EBRT)
20 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Low int)
21 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Mid int)
22 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (High int)
23 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds)
24 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds & EBRT)
25 Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and Distant Metastases-free Survival Outcomes. Int J Oncol Bio Phys 2008;71(4):
26 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT & Seeds)
27. Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185:
28 Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176:
29 Zelefsky, M et al. Multi Institutional Analysis of Long term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
30. Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
31 (Open)
Dattoli, M et al. Long-term Outcomes after Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients having Intermediate and High-risk Features. Cancer 2007;110(3):
Moyad, M et al. Statins, Especially Atorvastatin, May Favorably Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & EBRT)
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & ADT)
Galalae, R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer: Is Escalation to Very High Biologically Equivalent Dose Beneficial in All Prognostic Risk Groups? Strahlenther Onkol 2006;182(3):
Taira, A et al. Natural History of Clinically Staged Low and Intermediate risk Prostate Cancer Treated with Monotherapeutic Permanent Interstitial Brachytherapy Int J Radiat Oncol Bio Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes, J et al. Excellent Results from HDR Brachytherapy and EBRT for PCA are not Improved by Androgen deprivation Amer J Clin Oncology 2009;32(4):
Stone, N et al. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes Int J Radiat Oncol Bio Phys 2010;76(2):
Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Radiation and Brachytherapy J Oncology 2010; 2010(Art. Id ): 6 pages.
Menon, M et al. Biochemical Recurrence Following Robot Assisted RP: Analysis of 1384 patients with a median 5 year Follow-up. Eur Urol 2010; 58: (Robot)
Munro, N et al. ( Leeds) Outcomes for Gleason Score 7, intermediate risk Localized Prostate Cancer Treated with I-125 monotherapy over 10 years. Radiother Oncol 2010;96(1):34-37.
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (RP)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Proatate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (Seeds)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (EBRT)
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients treated with I-125 Permanent Prostate Brachytherapy. Int J Rad Onc Biol Phys 2010;76(5):
47.. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ; 20
HDR
EBRT, Seeds + ADT
← Years from Treatment → 21 22
Protons
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

23. INTERMEDIATE RISK RESULTS
Weighted
EBRT & Seeds
Brachy
% PSA Progression Free 33 24 23 13
Robot RP 14 37 35 34
Seeds + ADT 15 44 40 + 16 4 32
EBRT & Seeds 30 36 38 45 39 6 12
Hypo EBRT 3 42 43 47 27 18 17
Seeds Alone 5 26 28 19 9
Treatment Success 7 25 41 29 1 8 2 10 11 46
EBRT
1st Group References:
Bahn, D et al. Targeted Cryo-Ablation of the Prostate:7 yr Outcomes in Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
3 Critz, F et al. 10-Year Disease Free Survival Rates after Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation and Methodology. J Urology 2004;172:
4 Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal high Dose Brachytherapy Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
5 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (RP)
6 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (Seeds)
7 Kupelian, P et al. Imporved biochemial Relapse-Free Survival With Increased External Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in patients in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
8 Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Bio Phys 2003;57(4):
9 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT)
10 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (RP)
11 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (Seeds)
12 Martin, A et al. Permanent Prostate Implant Using High activity Seeds and Inverse Planning with Fast simulated annealing Algorithm: 12 Year Canadian Experience Int J Radiat Oncol Bio Phys 2007;67(2):
13 Merrick G, et al. Androgen Deprivation Therapy Dose not Impact Cause Specific Overall Survival after Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3):
14 Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. J Urology 2005;66(5):
15 Phan, T, et al. High Dose Rate Brachytherapy as a Boost for the Treatment of Localized Prostate Cancer. J Urology 2002;177:
16 Burri, R et al. Young Men Have Equivalent Biochmical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer Int J Radiat Oncol Bio Phys 2010; 77(5):
17 Potters, L et al. 12 year Outcomes Following Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer J Urol 2005;173:
18 Rossi, C et al. Conformal Proton Beam Radiation Therapy for Prostate Cancer: Concepts & Clinical Results. Comm Oncol 2007;4:
19 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (EBRT)
20 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Low int)
21 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Mid int)
22 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (High int)
23 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds)
24 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds & EBRT)
25 Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and Distant Metastases-free Survival Outcomes. Int J Oncol Bio Phys 2008;71(4):
26 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT & Seeds)
27 . Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185:
28 Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176:
29 Zelefsky, M et al. Multi Institutional Analysis of Long term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
30. Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.)
31 (Open)
Dattoli, M et al. Long-term Outcomes after Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients having Intermediate and High-risk Features. Cancer 2007;110(3):
Moyad, M et al. Statins, Especially Atorvastatin, May Favorably Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & EBRT)
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & ADT)
Galalae, R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer: Is Escalation to Very High Biologically Equivalent Dose Beneficial in All Prognostic Risk Groups? Strahlenther Onkol 2006;182(3):
Taira, A et al. Natural History of Clinically Staged Low and Intermediate risk Prostate Cancer Treated with Monotherapeutic Permanent Interstitial Brachytherapy Int J Radiat Oncol Bio Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes, J et al. Excellent Results from HDR Brachytherapy and EBRT for PCA are not Improved by Androgen deprivation Amer J Clin Oncology 2009;32(4):
Stone, N et al. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes Int J Radiat Oncol Bio Phys 2010;76(2):
Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Radiation and Brachytherapy J Oncology 2010; 2010(Art. Id ): 6 pages.
Menon, M et al. Biochemical Recurrence Following Robot Assisted RP: Analysis of 1384 patients with a median 5 year Follow-up. Eur Urol 2010; 58: (Robot)
Munro, N et al. ( Leeds) Outcomes for Gleason Score 7, intermediate risk Localized Prostate Cancer Treated with I-125 monotherapy over 10 years. Radiother Oncol 2010;96(1):34-37.
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (RP)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Proatate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (Seeds)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (EBRT)
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients treated with I-125 Permanent Prostate Brachytherapy. Int J Rad Onc Biol Phys 2010;76(5):
47.. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ;
Surgery 20
HDR
EBRT, Seeds + ADT
← Years from Treatment → 21 22
Protons
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

24. INTERMEDIATE RISK RESULTS
>40 months follow-up or less than 100 patients
% PSA Progression Free
EBRT + ADT 54 56
104 59 33 24 66 59 55
Robot RP 79 14 23 13 37 35 59 92 98 34
Seeds + ADT 15 44 96 40 +
Treatment Success 30 57 16 4 38 32
EBRT & Seeds 36 45 68 69 58
105 99 77 12 39 83 82 97 6 42 73
Hypo EBRT 51 91 3 64 43 72 62 63 93 47 86 71 17 27 18 50 81 95
Seeds Alone 74 67 90 26 28 19 5 9 52 78 65 70 7 25
103
102 76 41 29 60
100 1 85 88 53 8 87 2 10 75
101 11 46 84
1st Group References:
Bahn, D et al. Targeted Cryo-Ablation of the Prostate:7 yr Outcomes in Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
3 Critz, F et al. 10-Year Disease Free Survival Rates after Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation and Methodology. J Urology 2004;172:
4 Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal high Dose Brachytherapy Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
5 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (RP)
6 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (Seeds)
7 Kupelian, P et al. Imporved biochemial Relapse-Free Survival With Increased External Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in patients in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
8 Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Bio Phys 2003;57(4):
9 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT)
10 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (RP)
11 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (Seeds)
12 Martin, A et al. Permanent Prostate Implant Using High activity Seeds and Inverse Planning with Fast simulated annealing Algorithm: 12 Year Canadian Experience Int J Radiat Oncol Bio Phys 2007;67(2):
13 Merrick G, et al. Androgen Deprivation Therapy Dose not Impact Cause Specific Overall Survival after Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3):
14 Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. J Urology 2005;66(5):
15 Phan, T, et al. High Dose Rate Brachytherapy as a Boost for the Treatment of Localized Prostate Cancer. J Urology 2002;177:
16 Burri, R et al. Young Men Have Equivalent Biochmical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer Int J Radiat Oncol Bio Phys 2010; 77(5):
17 Potters, L et al. 12 year Outcomes Following Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer J Urol 2005;173:
18 Rossi, C et al. Conformal Proton Beam Radiation Therapy for Prostate Cancer: Concepts & Clinical Results. Comm Oncol 2007;4:
19 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (EBRT)
20 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Low int)
21 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Mid int)
22 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (High int)
23 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds)
24 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds & EBRT)
25 Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and Distant Metastases-free Survival Outcomes. Int J Oncol Bio Phys 2008;71(4):
26 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT & Seeds)
27 Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185: )
28 Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176:
29 Zelefsky, M et al. Multi Institutional Analysis of Long term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
30 Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.)
31 (Open)
Dattoli, M et al. Long-term Outcomes after Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients having Intermediate and High-risk Features. Cancer 2007;110(3):
Moyad, M et al. Statins, Especially Atorvastatin, May Favorably Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & EBRT)
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & ADT)
Galalae, R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer: Is Escalation to Very High Biologically Equivalent Dose Beneficial in All Prognostic Risk Groups? Strahlenther Onkol 2006;182(3):
Taira, A et al. Natural History of Clinically Staged Low and Intermediate risk Prostate Cancer Treated with Monotherapeutic Permanent Interstitial Brachytherapy Int J Radiat Oncol Bio Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes, J et al. Excellent Results from HDR Brachytherapy and EBRT for PCA are not Improved by Androgen deprivation Amer J Clin Oncology 2009;32(4):
Stone, N et al. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes Int J Radiat Oncol Bio Phys 2010;76(2):
Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Radiation and Brachytherapy J Oncology 2010; 2010(Art. Id ): 6 pages.
Menon, M et al. Biochemical Recurrence Following Robot Assisted RP: Analysis of 1384 patients with a median 5 year Follow-up. Eur Urol 2010; 58: (Robot)
Munro, N et al. ( Leeds) Outcomes for Gleason Score 7, intermediate risk Localized Prostate Cancer Treated with I-125 monotherapy over 10 years. Radiother Oncol 2010;96(1):34-37.
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (RP)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Proatate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (Seeds)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (EBRT)
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
47.. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ;
2nd Group References:
50. Hernandez D, et al. Contemporary Evaluation of the D'Amico Risk Classification of Prostate Cancer. Urology 2007;70(5):
51. Koontz B, et al. Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer. Brachytherapy 2009;8:
52. Stokes S, et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000:47(1): (RP)
53. Stokes S, et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000:47(1): (Seeds)
54. Merrick G, et al. Brachytherapy in Men aged <54 years with clinically localized prostate cancer. BJU Int 2006;98:
55. Merrick G, et al. Impact of Supplemental External beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After permanent Prostate Brachytherapy. Int J Oncol Bio Phys, 2005;61(1): (seeds)
56. Merrick G, et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Oncol Bio Phys, 2005;61(1): (seeds & EBRT)
57. Nobes J, et al. Biochemical Relapse-Free Survival in 400 Patients Treated with I-125 Prostate Brachytherapy: the Guildford Experience. Prostate cancer & Prostatic Disease 2009;12:61-66.
58. Demanes D, et al. High-Dose-Rate Intensity-Modulated Brachytherapy with external beam radiotherapy for prostate cancer: California Endocurietherapy’s 10-Year results. Int J Radiat Oncol Bio Phys 2005;61(5):
59. Yamada Y, et al. Favorable clinical outcomes of three-dimensional computer-optimized high-dose-rate prostate brachytherapy in the management of localized prostate cancer. Brachytherapy 2006;5:
60. Rossi C, et al. Conformal proton beam radiation therapy for prostate cancer: concepts and clinical results. Comm Oncol 2007;4(4):
61. (Open)
62. Yassa M, et al. Combined hypofractionated radiation and hormone therapy for the treatment of intermediate-risk prostate cancer. Int J Radiat Oncol Bio Phys 2008;71(1):58-63.
63. Cahlon O, et al . Ultra-high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Bio Phys 2008;71(2):
64. Sylvester J, et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy; Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64.
65. Cohen J, et al. Ten-Year Biochemical Disease Control for patients with Prostate Cancer Treated with Cyrosurgery as Primary Therapy. J Urol 2008;71(3):
66. Bachand F, et al. An Eight-Year Experience of HDR Brachytherapy Boost for Localized Prostate cancer: Biopsy and PSA outcome. Int J Radiat Oncol Bio Phys 2009;73(3):
67. Beyer D, et al. Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. Brachytherapy 2003;2:77-84.
68. Ellis R, et al. Biochemical Disease-free Survival rates following Definitive Low-Dose-Rate Prostate Brachytherapy with Dose Escalation to Biologic Target Volumes identified with SPECT/CT capromab pendetide. Brachytherapy 2007;6:16-25.
69. Kuban D, et al. Long term results of the MD Anderson randomized dose escalation trial for prostate cancer. Int J Radiat Oncol Bio Phys 2008;70(1):67-74.
70. Blana A, et al. Eight Years’ Experience with High-Intensity Focused Ultrasonography for Treatment of localized prostate cancer. J Urol 2008;72(6):
71. Grimm P, et al. 10-Year Biochemical (Prostate-specific antigen) control of prostate cancer with I-125 Brachytherapy. Int J Radiat Oncol Bio Phys 2001;51(1):31-40.
72. Shapiro E, et al. Long-Term Outcomes in Younger Men Following Permanent Prostate Brachytherapy. J Urology 2009;181: (Seeds <60yr old)
73. Shapiro E, et al. Long-Term Outcomes in Younger Men Following Permanent Prostate Brachytherapy. J Urology 2009;181: (Seeds >60yr old)
74. Zietman A, et al. Comparison of Conventional-Dose vs High-Dose Conformal Radiation Therapy in Clincially Localized Prostate Cancer. JAMA 2005;294(10): & CORRECTION JAMA 2008;299(8):
75. Kwok Y, et al. Risk Group Stratification in Patients undergoing permanent I-125 prostate brachytherapy as monotherapy. Int J Radiat Oncol Bio Phys 2002;53(3):
76. Zelefsky M, et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (75-81 Gy )
77. Khunita D, et al. Recurrence-free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in prostate specific antigen era. Cancer 2004;100(6):
78. Vora S, et al. Analysis of biochemical control and prognostic factors in patients treated with either low-dose three-dimensional conformal radiation therapy or high-dose intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Bio Phys 2007;68(4):
79. Stone N, et al. Customized Dose prescription for Permanent Prostate Brachytherapy : Insights from Multicenter Analysis of Dosimetry Outcomes. Int J Radiat Oncol Bio Phys 2007;69(5): (High dose: >200Gy)
80. Misrai V, et al. Oncologic Control provided by HIFU therapy as single treament with clinically localized prostate cancer. World J Urol 2008;26:
81. Henry, A, et al. Outcomes Following Iodine-125 Monotherapy for localized Prostate Cancer: The Results of Leeds 10-year single-center brachytherapy experience. Int. J. Radiat Oncol Bio Phys 2010;76(1):50-56.
82. Aizer A, et al. Radical Prostatectomy vs. Intensity-Modulated Radiation Therapy in the Management of Localized Prostate Cancer. Radiotherapy and Oncology 2009;93:
83. Prada P, et al. Prostate-Specific Antigen Relapse-Free Survival and Side-Effects in 734 Patients with up to 10 years of Follow-up with Localized Prostate Cancer Treated by permanent 125-Iodine Implants. BJU Int 2010;106(1):32-36.
84. Vassil A, et al. Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after Radical Prostatectomy, External Beam Radiation Therapy, or Permanent Seed Implantation. Urology 2010;76(5): (Robot)
85. Deger S, et al. High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urol 2005;47:
86. D’Amico A, et al. Biochemical Outcome after Radical Prostatectomy or External Beam Radiation Therapy for Patients with Clinically Localized Prostate Carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (low vol- RP)
87. D’Amico A, et al. Biochemical Outcome after Radical Prostatectomy or External Beam Radiation Therapy for Patients with Clinically Localized Prostate Carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (low vol- EBRT)
88. Battermann J, et al. Results of Permanent Prostate Brachytherapy, 13 years of experience at a Single Institution. Radiotherapy & Oncol 2004;71:23-28.
89. Livsey J, et al. Hypofractionated Conformal Radiotherapy In Carcinoma of the Prostate: five-year outcome analysis. Int J Radiat Oncol Bio Phys 2003;57(5):
90. Lederman G, et al. Retrospective Stratification of a Consecutive Cohort of Prostate Cancer Patients Treated with a Combined Regimen of External-beam Radiotherapy and Brachytherapy. Int J Radiat Oncol Bio Phys 2001;49(5):
91. Kollmeier M, et al. Biochemical Outcomes after Prostate brachytherapy with 5-year minimal follow-up: importance of patient selection and implant quality. Int J Radiat Oncol Bio Phys 2003;57(3):
92. Khaksar S, et al. Interstitial Low Dose Rate Brachytherapy for Prostate Cancer- A Focus on Intermediate & High Risk Disease. Clinical Oncol 2006;18:
93. Hull G, et al. Cancer Control with Radical Prostatectomy alone in 1000 Consecutive Patients. J Urol 2002;167:
94. Higgins G, et al. Outcome Analysis of 300 Prostate Cancer Patients Treated With Neoadjuvant Androgen Deprivation & Hypofractionated Radiotherapy. Int J Radiat Oncol Bio Phys 2006;65(4):
95. Sylvester J, et al. Ten Year Biochemical Relapse Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience. Int J Radiat Oncol Bio Phys 2003;57(4):
96. Zelefsky M, et al. Five-Year Outcome of Intraoperative Conformal Permanent I-125 Interstitial Implantation for Patients With Clinically Localized Prostate Cancer. Int J Oncol Bio Phys 2007;67(1):65-70.
97. Blasko J, et al. Palladium-103 Brachytherapy for Prostate Carcinoma. Int J Radiat Oncol Biol Phys 2000;46(4):
Stock, R, et al. Impact of Hormonal Therapy on Intermediate Risk Prostate Cancer Treated with Combination Brachytherapy and External Beam Irradiation. J Urol 2010;183:
99. Kupelian P, et al. Hypofractionated Intensity-Modulated Radiotherapy (70Gy at 2.5Gy per fraction) for Localized Prostate Cancer: Cleveland Clinic Experience. Int J Radiat Oncol Bio Phys 2007;68(5):
100. Tang J, et al. A prospective dose Escalation Trial of High-dose-rate Brachyhteapy Boost for Prostate Cancer: Evidence of hypofractionation efficacy? Brachytherapy 2006;5:
101. Crouzet S, et al. Multicentric Oncologic Outcomes of High-Intensity Focused Ultrasound for Localized Prostate Cancer in 803 patients. Eurr Urol 2010;58:
102. Colberg J, et al. Surgery versus Implant for early Prostate Cancer: Results from a Single Institution, Cancer 2007;13(4): (RP)
103. Colberg J, et al. Surgery versus Implant for early Prostate Cancer: Results from a Single Institution, Cancer 2007;13(4): (Seeds)
104. Deutsch, I et al. Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT. Brachytherapy 2010;9: (HDR)
105. Deutsch, I et al. Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT. Brachytherapy 2010;9: (IMRT) 94 89 20
HDR
EBRT, Seeds + ADT
← Years from Treatment → 21
Protons 80 22
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

25. INTERMEDIATE RISK RESULTS weighted
>40 months follow-up or less than 100 patients
Brachy
% PSA Progression Free
EBRT + ADT 54 56
104 59 33 24 66 55 14 23 13
Robot RP 37
EBRT 79 35 92 98 34
Seeds + ADT 15 44 96 40 + 57 16 4 38 32
EBRT & Seeds 30 36 45 68 69 58 99 77
105 12 39 83 82 97 6 42 73
Hypo EBRT 51 91 3 64 43 72 62 63 93 47 86 71 17 27 18 50 81 95
Seeds Alone 74 67 90 26 28 19 5 9 52
Treatment Success 78 65 70 7 25
103
102 29 76 41 60
100 1 85 88 53 8 87 2 10 75
101 11 46 84
1st Group References:
Bahn, D et al. Targeted Cryo-Ablation of the Prostate:7 yr Outcomes in Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
3 Critz, F et al. 10-Year Disease Free Survival Rates after Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation and Methodology. J Urology 2004;172:
4 Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal high Dose Brachytherapy Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
5 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (RP)
6 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (Seeds)
7 Kupelian, P et al. Imporved biochemial Relapse-Free Survival With Increased External Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in patients in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
8 Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Bio Phys 2003;57(4):
9 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT)
10 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (RP)
11 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (Seeds)
12 Martin, A et al. Permanent Prostate Implant Using High activity Seeds and Inverse Planning with Fast simulated annealing Algorithm: 12 Year Canadian Experience Int J Radiat Oncol Bio Phys 2007;67(2):
13 Merrick G, et al. Androgen Deprivation Therapy Dose not Impact Cause Specific Overall Survival after Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3):
14 Merrick G, et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. J Urology 2005;66(5):
15 Phan, T, et al. High Dose Rate Brachytherapy as a Boost for the Treatment of Localized Prostate Cancer. J Urology 2002;177:
16 Burri, R et al. Young Men Have Equivalent Biochmical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer Int J Radiat Oncol Bio Phys 2010; 77(5):
17 Potters, L et al. 12 year Outcomes Following Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer J Urol 2005;173:
18 Rossi, C et al. Conformal Proton Beam Radiation Therapy for Prostate Cancer: Concepts & Clinical Results. Comm Oncol 2007;4:
19 Klein E, et al. Outcomes for Intermediate Risk Prostate Cancer: Are There Advantage For Surgery, External Beam, or Brachytherapy. Urologic Oncology 2009;27(1): (EBRT)
20 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Low int)
21 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (Mid int)
22 Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups Int J Radiat Oncol Bio Phys 2006;65(4): (High int)
23 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds)
24 Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008; 72(2): (Seeds & EBRT)
25 Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and Distant Metastases-free Survival Outcomes. Int J Oncol Bio Phys 2008;71(4):
26 Kupelian, P et al. Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy ≥72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(1): (EBRT & Seeds)
27 Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185:
28 Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176:
29 Zelefsky, M et al. Multi Institutional Analysis of Long term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Biol Phys 2007;67(2):
30 Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
31 (Open)
Dattoli, M et al. Long-term Outcomes after Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients having Intermediate and High-risk Features. Cancer 2007;110(3):
Moyad, M et al. Statins, Especially Atorvastatin, May Favorably Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & EBRT)
Ho, A et al. Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated with Low-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2009;75(1): (Seeds & ADT)
Galalae, R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer: Is Escalation to Very High Biologically Equivalent Dose Beneficial in All Prognostic Risk Groups? Strahlenther Onkol 2006;182(3):
Taira, A et al. Natural History of Clinically Staged Low and Intermediate risk Prostate Cancer Treated with Monotherapeutic Permanent Interstitial Brachytherapy Int J Radiat Oncol Bio Phys 2010;76(2): Update Paper: Taira, A et al. Long-Term Outcomes for Clinically Licalized Prostate Cancer Treated with Permanene Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys, 2011;79(5):
Demanes, J et al. Excellent Results from HDR Brachytherapy and EBRT for PCA are not Improved by Androgen deprivation Amer J Clin Oncology 2009;32(4):
Stone, N et al. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes Int J Radiat Oncol Bio Phys 2010;76(2):
Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Radiation and Brachytherapy J Oncology 2010; 2010(Art. Id ): 6 pages.
Menon, M et al. Biochemical Recurrence Following Robot Assisted RP: Analysis of 1384 patients with a median 5 year Follow-up. Eur Urol 2010; 58: (Robot)
Munro, N et al. ( Leeds) Outcomes for Gleason Score 7, intermediate risk Localized Prostate Cancer Treated with I-125 monotherapy over 10 years. Radiother Oncol 2010;96(1):34-37.
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (RP)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Proatate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (Seeds)
Vassil, A et al. ( Cleveland Clinic) Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after RP, EBRT, or Permanent Seed Implantation Urology 2010;76(5): (EBRT)
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
47.. Gonzales , S et al RP vs EBRT for Localized PCa: Long Term Effect on Biochemical Ocntrol Ann Surg Oncol ;
2nd Group References:
50. Hernandez D, et al. Contemporary Evaluation of the D'Amico Risk Classification of Prostate Cancer. Urology 2007;70(5):
51. Koontz B, et al. Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer. Brachytherapy 2009;8:
52. Stokes S, et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000:47(1): (RP)
53. Stokes S, et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000:47(1): (Seeds)
54. Merrick G, et al. Brachytherapy in Men aged <54 years with clinically localized prostate cancer. BJU Int 2006;98:
55. Merrick G, et al. Impact of Supplemental External beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After permanent Prostate Brachytherapy. Int J Oncol Bio Phys, 2005;61(1): (seeds)
56. Merrick G, et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Oncol Bio Phys, 2005;61(1): (seeds & EBRT)
57. Nobes J, et al. Biochemical Relapse-Free Survival in 400 Patients Treated with I-125 Prostate Brachytherapy: the Guildford Experience. Prostate cancer & Prostatic Disease 2009;12:61-66.
58. Demanes D, et al. High-Dose-Rate Intensity-Modulated Brachytherapy with external beam radiotherapy for prostate cancer: California Endocurietherapy’s 10-Year results. Int J Radiat Oncol Bio Phys 2005;61(5):
59. Yamada Y, et al. Favorable clinical outcomes of three-dimensional computer-optimized high-dose-rate prostate brachytherapy in the management of localized prostate cancer. Brachytherapy 2006;5:
60. Rossi C, et al. Conformal proton beam radiation therapy for prostate cancer: concepts and clinical results. Comm Oncol 2007;4(4):
61. (Open)
62. Yassa M, et al. Combined hypofractionated radiation and hormone therapy for the treatment of intermediate-risk prostate cancer. Int J Radiat Oncol Bio Phys 2008;71(1):58-63.
63. Cahlon O, et al . Ultra-high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Bio Phys 2008;71(2):
64. Sylvester J, et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy; Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64.
65. Cohen J, et al. Ten-Year Biochemical Disease Control for patients with Prostate Cancer Treated with Cyrosurgery as Primary Therapy. J Urol 2008;71(3):
66. Bachand F, et al. An Eight-Year Experience of HDR Brachytherapy Boost for Localized Prostate cancer: Biopsy and PSA outcome. Int J Radiat Oncol Bio Phys 2009;73(3):
67. Beyer D, et al. Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. Brachytherapy 2003;2:77-84.
68. Ellis R, et al. Biochemical Disease-free Survival rates following Definitive Low-Dose-Rate Prostate Brachytherapy with Dose Escalation to Biologic Target Volumes identified with SPECT/CT capromab pendetide. Brachytherapy 2007;6:16-25.
69. Kuban D, et al. Long term results of the MD Anderson randomized dose escalation trial for prostate cancer. Int J Radiat Oncol Bio Phys 2008;70(1):67-74.
70. Blana A, et al. Eight Years’ Experience with High-Intensity Focused Ultrasonography for Treatment of localized prostate cancer. J Urol 2008;72(6):
71. Grimm P, et al. 10-Year Biochemical (Prostate-specific antigen) control of prostate cancer with I-125 Brachytherapy. Int J Radiat Oncol Bio Phys 2001;51(1):31-40.
72. Shapiro E, et al. Long-Term Outcomes in Younger Men Following Permanent Prostate Brachytherapy. J Urology 2009;181: (Seeds <60yr old)
73. Shapiro E, et al. Long-Term Outcomes in Younger Men Following Permanent Prostate Brachytherapy. J Urology 2009;181: (Seeds >60yr old)
74. Zietman A, et al. Comparison of Conventional-Dose vs High-Dose Conformal Radiation Therapy in Clincially Localized Prostate Cancer. JAMA 2005;294(10): & CORRECTION JAMA 2008;299(8):
75. Kwok Y, et al. Risk Group Stratification in Patients undergoing permanent I-125 prostate brachytherapy as monotherapy. Int J Radiat Oncol Bio Phys 2002;53(3):
76. Zelefsky M, et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (75-81 Gy )
77. Khunita D, et al. Recurrence-free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in prostate specific antigen era. Cancer 2004;100(6):
78. Vora S, et al. Analysis of biochemical control and prognostic factors in patients treated with either low-dose three-dimensional conformal radiation therapy or high-dose intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Bio Phys 2007;68(4):
79. Stone N, et al. Customized Dose prescription for Permanent Prostate Brachytherapy : Insights from Multicenter Analysis of Dosimetry Outcomes. Int J Radiat Oncol Bio Phys 2007;69(5): (High dose: >200Gy)
80. Misrai V, et al. Oncologic Control provided by HIFU therapy as single treament with clinically localized prostate cancer. World J Urol 2008;26:
81. Henry, A, et al. Outcomes Following Iodine-125 Monotherapy for localized Prostate Cancer: The Results of Leeds 10-year single-center brachytherapy experience. Int. J. Radiat Oncol Bio Phys 2010;76(1):50-56.
82. Aizer A, et al. Radical Prostatectomy vs. Intensity-Modulated Radiation Therapy in the Management of Localized Prostate Cancer. Radiotherapy and Oncology 2009;93:
83. Prada P, et al. Prostate-Specific Antigen Relapse-Free Survival and Side-Effects in 734 Patients with up to 10 years of Follow-up with Localized Prostate Cancer Treated by permanent 125-Iodine Implants. BJU Int 2010;106(1):32-36.
84. Vassil A, et al. Five Year Biochemical recurrence Free Survival for Intermediate Risk Prostate Cancer after Radical Prostatectomy, External Beam Radiation Therapy, or Permanent Seed Implantation. Urology 2010;76(5): (Robot)
85. Deger S, et al. High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urol 2005;47:
86. D’Amico A, et al. Biochemical Outcome after Radical Prostatectomy or External Beam Radiation Therapy for Patients with Clinically Localized Prostate Carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (low vol- RP)
87. D’Amico A, et al. Biochemical Outcome after Radical Prostatectomy or External Beam Radiation Therapy for Patients with Clinically Localized Prostate Carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (low vol- EBRT)
88. Battermann J, et al. Results of Permanent Prostate Brachytherapy, 13 years of experience at a Single Institution. Radiotherapy & Oncol 2004;71:23-28.
89. Livsey J, et al. Hypofractionated Conformal Radiotherapy In Carcinoma of the Prostate: five-year outcome analysis. Int J Radiat Oncol Bio Phys 2003;57(5):
90. Lederman G, et al. Retrospective Stratification of a Consecutive Cohort of Prostate Cancer Patients Treated with a Combined Regimen of External-beam Radiotherapy and Brachytherapy. Int J Radiat Oncol Bio Phys 2001;49(5):
91. Kollmeier M, et al. Biochemical Outcomes after Prostate brachytherapy with 5-year minimal follow-up: importance of patient selection and implant quality. Int J Radiat Oncol Bio Phys 2003;57(3):
92. Khaksar S, et al. Interstitial Low Dose Rate Brachytherapy for Prostate Cancer- A Focus on Intermediate & High Risk Disease. Clinical Oncol 2006;18:
93. Hull G, et al. Cancer Control with Radical Prostatectomy alone in 1000 Consecutive Patients. J Urol 2002;167:
94. Higgins G, et al. Outcome Analysis of 300 Prostate Cancer Patients Treated With Neoadjuvant Androgen Deprivation & Hypofractionated Radiotherapy. Int J Radiat Oncol Bio Phys 2006;65(4):
95. Sylvester J, et al. Ten Year Biochemical Relapse Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience. Int J Radiat Oncol Bio Phys 2003;57(4):
96. Zelefsky M, et al. Five-Year Outcome of Intraoperative Conformal Permanent I-125 Interstitial Implantation for Patients With Clinically Localized Prostate Cancer. Int J Oncol Bio Phys 2007;67(1):65-70.
97. Blasko J, et al. Palladium-103 Brachytherapy for Prostate Carcinoma. Int J Radiat Oncol Biol Phys 2000;46(4):
Stock, R, et al. Impact of Hormonal Therapy on Intermediate Risk Prostate Cancer Treated with Combination Brachytherapy and External Beam Irradiation. J Urol 2010;183:
99. Kupelian P, et al. Hypofractionated Intensity-Modulated Radiotherapy (70Gy at 2.5Gy per fraction) for Localized Prostate Cancer: Cleveland Clinic Experience. Int J Radiat Oncol Bio Phys 2007;68(5):
100. Tang J, et al. A prospective dose Escalation Trial of High-dose-rate Brachyhteapy Boost for Prostate Cancer: Evidence of hypofractionation efficacy? Brachytherapy 2006;5:
101. Crouzet S, et al. Multicentric Oncologic Outcomes of High-Intensity Focused Ultrasound for Localized Prostate Cancer in 803 patients. Eurr Urol 2010;58:
102. Colberg J, et al. Surgery versus Implant for early Prostate Cancer: Results from a Single Institution, Cancer 2007;13(4): (RP)
103. Colberg J, et al. Surgery versus Implant for early Prostate Cancer: Results from a Single Institution, Cancer 2007;13(4): (Seeds)
104. Deutsch, I et al. Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT. Brachytherapy 2010;9: (HDR)
105. Deutsch, I et al. Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT. Brachytherapy 2010;9: (IMRT) 94
Surgery 89 20
HDR
EBRT, Seeds +
ADT
← Years from Treatment → 21 80 22
Protons
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

26. High Risk Patient Definition
Zelefsky definition
2 or more factors
Gleason > 7
PSA Clinical Stage T1c- T2b
D'Amico
Gleason Score 8-10
PSA >20
3/24/2017

27. HIGH RISK RESULTS % PSA Progression Free Treatment Success Protons HDR20 16 45
109 19 18 4
108
100
EBRT & ADT 38 22
Treatment Success 17
EBRT & Seeds 40 37 3 43 47 34 32
Hypo EBRT 44 9 41 2
104 48 10 28 13 36 42 24 1 12 8 25
101
110
106 33 21 5 14 39
103 11 26 7 6
1st Group References:
1. Bahn, D et al. Targeted Cryoablation of the Prostate:7-year Outcomes in the Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
2. Burri, R et al. Young Men have Equivalent Biochemical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer. Int J Radiat Oncol Bio Phys 2010;77(5):
3. Ploussard, G et al. Radical Prostatectomy of High-Risk Prostate Cancer Defined by Preoperative criteria: Oncologic Follow-up in National Multicenter Study in 813 Patients and Assessment of Easy-to-use Prognostic Substratification. Urol 2011;78(3):607-13
4. Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008;72(2):
5. Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
6. Carver, B et al. Long Term Outcome following Radical Prostatectomy in Men with Clinical T3 Prostate Cancer. J Urology 2006;176:
7. Cohen, J et al. Ten-Year Biochemical Disease Control in Patients with Prostate Cancer Treated with Cryosurgery as Primary Therapy. Urology 2008;71(3):
8. Critz, Fet al. 10-year Disease Survival Rates After Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation Methodology. J Urology 2004;172:
9. Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal High-Dose-Rate Brachytherapy (HDR-BT) Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
10. Kollmeier, M et al. Biochemical Outcomes After Prostate Brachytherapy with 5-year Minimal follow-up: Importance of patient Selection and implant Quality. Int J Radiat Oncol Bio Phys 2003;57(3):
11. Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Biol Phys 2003;57(4): (PSA:4-10,GS:2-6,>70 Gy)
12. Kuban, D et al. Long-Term Results of the MD Anderson Randomized Dose-Escalation Trial for Prostate Cancer. Int J Radiat Oncol Bio Phys 2008;70(1):67-74.
13. Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
14. Stenmark, M et al. Continued Benefit to Androgen Deprivation Therapy for Prostate Cancer Patients Treated with Dose-Escalated Radiation Therapy Across Multiple Definitions of High-Risk Disease. Int J Radiat Oncol Bio Phys 2011;81(4):
15. Loeb, S et al. Intermediate-term potency, continence & survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer. Urology 2007;69(6):
16. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3): (EBRT, Seeds, ADT) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
17. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int j Radiat Oncol Bio Phys 2006;65(3): (EBRT & Seeds) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
18. Merrick, G et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. Urology 2005;66(5):
19. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT & Seeds)
20. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT, Seeds, ADT)
21. Mian, B et al. Outcome of Patients w/ Gleason score 8 or Higher Prostate Cancer following Radical Prostatectomy alone. J Urology 2002;167:
22. Pellizzon, A et al. The Relationship Between the Biochemical Control Outcomes and the Quality of Planning of HDR as a Boost to External Beam Radiotherapy for locally and locally advanced Prostate Cancer using the RTOG-ASTRO Phoenix definition. Int J Med Sci 2008;5:
23. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (EBRT)
24. Potters, L et al. 12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients With Clinically Localized Prostate Cancer. J Urology 2005;173:
25. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (RP)
26. Sylvester, J et al. Ten Year Biochemical Relapse Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience. Int J Radiat Oncol Bio Phys 2003;57(4):
Lau, W et al. Radical Prostatectomy for Pathological Gleason 8 or Greater Prostate Cancer: Influence of Concomitant Pathological Variables. J Urol 2002;167:
Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185: Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups. Int J Radiat Oncol Bio Phys 2006;65(4):
30. Ward, J et al. Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer since the advent of PSA testing: 15 year outcome. BJU Int 2005;95:751-6.
31. Zelefsky, M et al. Multi-Institutional Analysis of Long-Term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Bio Phys 2007;67(2):
32. Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176: (81 Gy)
33. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol Bio Phys 2008;71(4): (81 Gy)
34. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol bio Phys 2008;71(4): (86 Gy)
35. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (75 Gy)
36. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (81 Gy)
37. Dattoli, M et al. Long-term Outcomes After Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients Having Intermediate and High-Risk Features. Cancer 2007;110(3):
38. Moyad, M et al. Statins, especially Atorvastatin, may Favorable Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
39. Zelefsky, M et al. Long Term Outcome Following Three dimensional Conformal/IMRT for Clinical Stage T3 Prostate Cancer. Eurr Urol 2008;53:
40. Yoshioka, Y et al. Monotherapeutic High-dose-rate Brachytherapy for Prostate Cancer: Five-year Results of an Extreme Hypofractionation Regimen with 54Gy in Nine Fractions. Int J Radiat Oncol Bio Phys 2011;80(2):
41. Galalae R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer. Strahlenther Onkol 2006;182(3):
42. Demanes, DJ et al. Excellent Results from High Dose Rate Brachytherapy and External Beam Radiation Therapy for Prostate Cancer are Not Imroved by Androgen Deprivation. Amer J Clin Oncol 2009;32(4):
43. Stock, R et al. Outcomes for patients with High-Grade Prostate Cancer Treated with a Combination of Brachytherapy, EBRT and Hormone therapy. BJU Int 2009;104:
44. Stone, N et al. Local Control following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes. Int J Radiat Oncol Bio Phys 2010;76(2):
45. Bittner, N et al. Whole Pelvis Radiotherapy in Combination with Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High Risk Prostate Cancer? Int J Radiat Oncol Bio Phys 2010;76(4):
46. Rubio-Briones, J et al. Metastatic Progression, Cancer Specific Mortality and Need for Secondary Treatments in Patients with Clinically High Risk Prostate Cancer Treated Initially with Radical Prostatectomy. Actas Urologicas Esanolas 2010;34(7):
47. Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Beam Irradiation and Brachytherapy. J Oncology 2010;2010(Article Id ):6 pages.
48. Menon, M et al. Biochemical Recurrence Following Robot Assisted Radical Prostatectomy: Analysis of 1384 patients with a median 5 year follow-up. Eurr Urol 2010;58:
Pierorazio, P et al. Long Term Survival after Radical Prostatectomy for Men with High Gleason Sum in Pathologic Specimen. Urology 2010;76(3):
Taira, A et al. Long-term Outcome for Clinically Localized Prostate Cancer Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;79(5):
Deger, S et al. (Germany) High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urology 2005;47:
Magheli A et al. (Johns Hopkins) Importance of Tumor Location in Patients with High Preoperative PSA Levels ( greater than 20 ng/ml treated with Radical Prostatectomy. J Urology 2007;178:
Kupelian P, et al. Improved Biochemical Relapse-Free Survival With Increased Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
Sylvester, J et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy: Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64.
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients Treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Hsu, C et al. Comparing Results After Surgery in Patients with Clinical Unilateral T3a Prostate Cnacer Treated with or without neoadjuvent Androgen-Deprivation Therapy. BJU Int 2006;99:
Roehl, K et al. Cancer Progression and Survival Rates Following Anatomical Radical Prostatectomy in 3,478 Consecutive Patients: Long Term Results. J Urology 2004;172:
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (No ADT)
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (Plus ADT)
Kuban, D et al. Long-Term Failure Patterns and Survival in a Randomized Dose-Escalation Trial for Prostate Cancer. Who Dies of Disease? Int J Radiat Oncol Bio Phys 2011;79(5): 35
Protons 31 30 46 27
107
102 15
HDR
105
EBRT Seeds +
ADT
← Years from Treatment → 23 29 49
Robot RP
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

28. HIGH RISK RESULTS EBRT, Seeds & ADT % PSA Progression Free Brachy
Weighted
EBRT, Seeds & ADT
% PSA Progression Free
Brachy 20 16 45
109 19 18 4
108
100
EBRT & ADT 38 22 17
EBRT & Seeds 40 37 3 43 47 34 32
Hypo EBRT 44 9 41 2
104 48 10 28 13 36 42 24 1 12 8 25
Treatment Success
101
110
106 33 21 5 14 39
Surgery
EBRT
103 11 26 7 6
1st Group References:
1. Bahn, D et al. Targeted Cryoablation of the Prostate:7-year Outcomes in the Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
2. Burri, R et al. Young Men have Equivalent Biochemical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer. Int J Radiat Oncol Bio Phys 2010;77(5):
3. Ploussard, G et al. Radical Prostatectomy of High-Risk Prostate Cancer Defined by Preoperative criteria: Oncologic Follow-up in National Multicenter Study in 813 Patients and Assessment of Easy-to-use Prognostic Substratification. Urol 2011;78(3):607-13
4. Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008;72(2):
5. Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
6. Carver, B et al. Long Term Outcome following Radical Prostatectomy in Men with Clinical T3 Prostate Cancer. J Urology 2006;176:
7. Cohen, J et al. Ten-Year Biochemical Disease Control in Patients with Prostate Cancer Treated with Cryosurgery as Primary Therapy. Urology 2008;71(3):
8. Critz, Fet al. 10-year Disease Survival Rates After Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation Methodology. J Urology 2004;172:
9. Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal High-Dose-Rate Brachytherapy (HDR-BT) Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
10. Kollmeier, M et al. Biochemical Outcomes After Prostate Brachytherapy with 5-year Minimal follow-up: Importance of patient Selection and implant Quality. Int J Radiat Oncol Bio Phys 2003;57(3):
11. Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Biol Phys 2003;57(4): (PSA:4-10,GS:2-6,>70 Gy)
12. Kuban, D et al. Long-Term Results of the MD Anderson Randomized Dose-Escalation Trial for Prostate Cancer. Int J Radiat Oncol Bio Phys 2008;70(1):67-74.
13. Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
14. Stenmark, M et al. Continued Benefit to Androgen Deprivation Therapy for Prostate Cancer Patients Treated with Dose-Escalated Radiation Therapy Across Multiple Definitions of High-Risk Disease. Int J Radiat Oncol Bio Phys 2011;81(4):
15. Loeb, S et al. Intermediate-term potency, continence & survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer. Urology 2007;69(6):
16. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3): (EBRT, Seeds, ADT) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
17. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int j Radiat Oncol Bio Phys 2006;65(3): (EBRT & Seeds) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
18. Merrick, G et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. Urology 2005;66(5):
19. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT & Seeds)
20. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT, Seeds, ADT)
21. Mian, B et al. Outcome of Patients w/ Gleason score 8 or Higher Prostate Cancer following Radical Prostatectomy alone. J Urology 2002;167:
22. Pellizzon, A et al. The Relationship Between the Biochemical Control Outcomes and the Quality of Planning of HDR as a Boost to External Beam Radiotherapy for locally and locally advanced Prostate Cancer using the RTOG-ASTRO Phoenix definition. Int J Med Sci 2008;5:
23. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (EBRT)
24. Potters, L et al. 12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients With Clinically Localized Prostate Cancer. J Urology 2005;173:
25. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (RP)
26. Sylvester, J et al. Ten Year Biochemical Relapse Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience. Int J Radiat Oncol Bio Phys 2003;57(4):
27. Lau, W et al. Radical Prostatectomy for Pathological Gleason 8 or Greater Prostate Cancer: Influence of Concomitant Pathological Variables. J Urol 2002;167:
28. Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185: )
29. Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups. Int J Radiat Oncol Bio Phys 2006;65(4):
30. Ward, J et al. Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer since the advent of PSA testing: 15 year outcome. BJU Int 2005;95:751-6.
31. Zelefsky, M et al. Multi-Institutional Analysis of Long-Term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Bio Phys 2007;67(2):
32. Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176: (81 Gy)
33. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol Bio Phys 2008;71(4): (81 Gy)
34. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol bio Phys 2008;71(4): (86 Gy)
35. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (75 Gy)
36. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (81 Gy)
37. Dattoli, M et al. Long-term Outcomes After Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients Having Intermediate and High-Risk Features. Cancer 2007;110(3):
38. Moyad, M et al. Statins, especially Atorvastatin, may Favorable Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
39. Zelefsky, M et al. Long Term Outcome Following Three dimensional Conformal/IMRT for Clinical Stage T3 Prostate Cancer. Eurr Urol 2008;53:
40. (Yoshioka, Y et al. Monotherapeutic High-dose-rate Brachytherapy for Prostate Cancer: Five-year Results of an Extreme Hypofractionation Regimen with 54Gy in Nine Fractions. Int J Radiat Oncol Bio Phys 2011;80(2): )
41. Galalae R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer. Strahlenther Onkol 2006;182(3):
42. Demanes, DJ et al. Excellent Results from High Dose Rate Brachytherapy and External Beam Radiation Therapy for Prostate Cancer are Not Imroved by Androgen Deprivation. Amer J Clin Oncol 2009;32(4):
43. Stock, R et al. Outcomes for patients with High-Grade Prostate Cancer Treated with a Combination of Brachytherapy, EBRT and Hormone therapy. BJU Int 2009;104:
44. Stone, N et al. Local Control following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes. Int J Radiat Oncol Bio Phys 2010;76(2):
45. Bittner, N et al. Whole Pelvis Radiotherapy in Combination with Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High Risk Prostate Cancer? Int J Radiat Oncol Bio Phys 2010;76(4):
46. Rubio-Briones, J et al. Metastatic Progression, Cancer Specific Mortality and Need for Secondary Treatments in Patients with Clinically High Risk Prostate Cancer Treated Initially with Radical Prostatectomy. Actas Urologicas Esanolas 2010;34(7):
47. Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Beam Irradiation and Brachytherapy. J Oncology 2010;2010(Article Id ):6 pages.
48. Menon, M et al. Biochemical Recurrence Following Robot Assisted Radical Prostatectomy: Analysis of 1384 patients with a median 5 year follow-up. Eurr Urol 2010;58:
Pierorazio, P et al. Long Term Survival after Radical Prostatectomy for Men with High Gleason Sum in Pathologic Specimen. Urology 2010;76(3):
Taira, A et al. Long-term Outcome for Clinically Localized Prostate Cancer Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;79(5):
Deger, S et al. (Germany) High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urology 2005;47:
Magheli A et al. (Johns Hopkins) Importance of Tumor Location in Patients with High Preoperative PSA Levels ( greater than 20 ng/ml treated with Radical Prostatectomy. J Urology 2007;178:
Kupelian P, et al. Improved Biochemical Relapse-Free Survival With Increased Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
Sylvester, J et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy: Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64.
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients Treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Hsu, C et al. Comparing Results After Surgery in Patients with Clinical Unilateral T3a Prostate Cnacer Treated with or without neoadjuvent Androgen-Deprivation Therapy. BJU Int 2006;99:
Roehl, K et al. Cancer Progression and Survival Rates Following Anatomical Radical Prostatectomy in 3,478 Consecutive Patients: Long Term Results. J Urology 2004;172:
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (No ADT)
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (Plus ADT)
Kuban, D et al. Long-Term Failure Patterns and Survival in a Randomized Dose-Escalation Trial for Prostate Cancer. Who Dies of Disease? Int J Radiat Oncol Bio Phys 2011;79(5): 35
Protons 31 30 46 27
107 15
HDR
102
105
EBRT Seeds +
ADT
← Years from Treatment → 23 29 49
Robot RP
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

29. HIGH RISK RESULTS >40 months follow-up or less than 100 patients
% PSA Progression Free 92 65 20 81 16 45
109 19 18 80 4 74
108
100
EBRT & ADT 78 38 22
Treatment Success 17 67 55
EBRT & Seeds 40 75 37 72 3 85 43 76 47 54 34 32
Hypo EBRT 91 44 66 9 41 2 79 68 57
104 28 71 13 64 48 10 36 59 42 24 50 56 1 12 8 53 25 61
101 90
110 89 62
106 33 21 5 14 70 39 60
103 83 11 26 82 6 7
1st Group References:
1. Bahn, D et al. Targeted Cryoablation of the Prostate:7-year Outcomes in the Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
2. Burri, R et al. Young Men have Equivalent Biochemical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer. Int J Radiat Oncol Bio Phys 2010;77(5):
3. Ploussard, G et al. Radical Prostatectomy of High-Risk Prostate Cancer Defined by Preoperative criteria: Oncologic Follow-up in National Multicenter Study in 813 Patients and Assessment of Easy-to-use Prognostic Substratification. Urol 2011;78(3):607-13
4. Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008;72(2):
5. Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
6. Carver, B et al. Long Term Outcome following Radical Prostatectomy in Men with Clinical T3 Prostate Cancer. J Urology 2006;176:
7. Cohen, J et al. Ten-Year Biochemical Disease Control in Patients with Prostate Cancer Treated with Cryosurgery as Primary Therapy. Urology 2008;71(3):
8. Critz, Fet al. 10-year Disease Survival Rates After Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation Methodology. J Urology 2004;172:
9. Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal High-Dose-Rate Brachytherapy (HDR-BT) Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
10. Kollmeier, M et al. Biochemical Outcomes After Prostate Brachytherapy with 5-year Minimal follow-up: Importance of patient Selection and implant Quality. Int J Radiat Oncol Bio Phys 2003;57(3):
11. Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Biol Phys 2003;57(4): (PSA:4-10,GS:2-6,>70 Gy)
12. Kuban, D et al. Long-Term Results of the MD Anderson Randomized Dose-Escalation Trial for Prostate Cancer. Int J Radiat Oncol Bio Phys 2008;70(1):67-74.
13. Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
14. Stenmark, M et al. Continued Benefit to Androgen Deprivation Therapy for Prostate Cancer Patients Treated with Dose-Escalated Radiation Therapy Across Multiple Definitions of High-Risk Disease. Int J Radiat Oncol Bio Phys 2011;81(4):
15. Loeb, S et al. Intermediate-term potency, continence & survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer. Urology 2007;69(6):
16. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3): (EBRT, Seeds, ADT) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
17. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int j Radiat Oncol Bio Phys 2006;65(3): (EBRT & Seeds) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
18. Merrick, G et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. Urology 2005;66(5):
19. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT & Seeds)
20. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT, Seeds, ADT)
21. Mian, B et al. Outcome of Patients w/ Gleason score 8 or Higher Prostate Cancer following Radical Prostatectomy alone. J Urology 2002;167:
22. Pellizzon, A et al. The Relationship Between the Biochemical Control Outcomes and the Quality of Planning of HDR as a Boost to External Beam Radiotherapy for locally and locally advanced Prostate Cancer using the RTOG-ASTRO Phoenix definition. Int J Med Sci 2008;5:
23. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (EBRT)
24. Potters, L et al. 12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients With Clinically Localized Prostate Cancer. J Urology 2005;173:
25. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (RP)
26. Sylvester, J et al. Ten Year Biochemical Relapse Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience. Int J Radiat Oncol Bio Phys 2003;57(4):
27. Lau, W et al. Radical Prostatectomy for Pathological Gleason 8 or Greater Prostate Cancer: Influence of Concomitant Pathological Variables. J Urol 2002;167: Open)
28. Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185: Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups. Int J Radiat Oncol Bio Phys 2006;65(4):
30. Ward, J et al. Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer since the advent of PSA testing: 15 year outcome. BJU Int 2005;95:751-6.
31. Zelefsky, M et al. Multi-Institutional Analysis of Long-Term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Bio Phys 2007;67(2):
32. Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176: (81 Gy)
33. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol Bio Phys 2008;71(4): (81 Gy)
34. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol bio Phys 2008;71(4): (86 Gy)
35. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (75 Gy)
36. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (81 Gy)
37. Dattoli, M et al. Long-term Outcomes After Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients Having Intermediate and High-Risk Features. Cancer 2007;110(3):
38. Moyad, M et al. Statins, especially Atorvastatin, may Favorable Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
39. Zelefsky, M et al. Long Term Outcome Following Three dimensional Conformal/IMRT for Clinical Stage T3 Prostate Cancer. Eurr Urol 2008;53:
40. Yoshioka, Y et al. Monotherapeutic High-dose-rate Brachytherapy for Prostate Cancer: Five-year Results of an Extreme Hypofractionation Regimen with 54Gy in Nine Fractions. Int J Radiat Oncol Bio Phys 2011;80(2):
41. Galalae R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer. Strahlenther Onkol 2006;182(3):
42. Demanes, DJ et al. Excellent Results from High Dose Rate Brachytherapy and External Beam Radiation Therapy for Prostate Cancer are Not Imroved by Androgen Deprivation. Amer J Clin Oncol 2009;32(4):
43. Stock, R et al. Outcomes for patients with High-Grade Prostate Cancer Treated with a Combination of Brachytherapy, EBRT and Hormone therapy. BJU Int 2009;104:
44. Stone, N et al. Local Control following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes. Int J Radiat Oncol Bio Phys 2010;76(2):
45. Bittner, N et al. Whole Pelvis Radiotherapy in Combination with Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High Risk Prostate Cancer? Int J Radiat Oncol Bio Phys 2010;76(4):
46. Rubio-Briones, J et al. Metastatic Progression, Cancer Specific Mortality and Need for Secondary Treatments in Patients with Clinically High Risk Prostate Cancer Treated Initially with Radical Prostatectomy. Actas Urologicas Esanolas 2010;34(7):
47. Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Beam Irradiation and Brachytherapy. J Oncology 2010;2010(Article Id ):6 pages.
48. Menon, M et al. Biochemical Recurrence Following Robot Assisted Radical Prostatectomy: Analysis of 1384 patients with a median 5 year follow-up. Eurr Urol 2010;58:
49. Pierorazio, P et al. Long Term Survival after Radical Prostatectomy for Men with High Gleason Sum in Pathologic Specimen. Urology 2010;76(3):
100. Taira, A et al. Long-term Outcome for Clinically Localized Prostate Cancer Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;79(5):
Deger, S et al. (Germany) High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urology 2005;47:
Magheli A et al. (Johns Hopkins) Importance of Tumor Location in Patients with High Preoperative PSA Levels ( greater than 20 ng/ml treated with Radical Prostatectomy. J Urology 2007;178:
Kupelian P, et al. Improved Biochemical Relapse-Free Survival With Increased Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
Sylvester, J et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy: Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64.
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients Treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Hsu, C et al. Comparing Results After Surgery in Patients with Clinical Unilateral T3a Prostate Cnacer Treated with or without neoadjuvent Androgen-Deprivation Therapy. BJU Int 2006;99:
Roehl, K et al. Cancer Progression and Survival Rates Following Anatomical Radical Prostatectomy in 3,478 Consecutive Patients: Long Term Results. J Urology 2004;172:
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (No ADT)
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (Plus ADT)
110. Kuban, D et al. Long-Term Failure Patterns and Survival in a Randomized Dose-Escalation Trial for Prostate Cancer. Who Dies of Disease? Int J Radiat Oncol Bio Phys 2011;79(5):
2nd Group References:
50. Aizer A, et al. Radical Prostatectomy vs Intensity-Modulated Radiation Therapy in the Management of Localized Prostate Adenocarcinoma. Radiotherapy and Oncology 2009;93:
51. Battermann J, et al. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiotherapy & Oncology 2004;71:23-28.
52. Berglund R, et al. Limited Pelvic Lymph Node Dissection at the Time of Radical Prostatectomy Does Not Affect 5-Year Failure Rates for Low, Intermediate and High Risk Prostate Cancer: Results From CaPSURE. J Urology 2007;177:
53. Beyer D, et al. Relative influence of gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. Brachytherapy 2003;2:77-84.
54. Cahlon O, et al. Ultra high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Bio Phys 2008;71(2):
55. Copp H, et al. Tumor Control Outcomes of Patients Treated With Trimodality Therapy For Locally Advanced Prostate Cancer. Urology 2005;65(6):
56. Crouzet S, et al. Multicentric Oncologic Outcomes of High-Intensity Focused Ultrasound for Localized Prostate Cancer in 803 patients. Eurr Urol 2010;58:
57. Demanes D, et al. High-Dose-Rate Intensity Modulated Brachytherapy With External Beam Radiotherapy for Prostate Cancer: California Endocurietherapy's 10-Year Results. Int J Radiat Oncol Bio Phys 2005;61(5):
Donohue J, et al. Poorly Differentiated Prostate Cancer Treated With Radical Prostatectomy: Long-Term Outcome and Incidence of Pathological Downgrading. J Urology 2006;176(3):
59. Ellis R, et al. Biochemical disease free survival rates following definitive low-dose-rate prostate brachytherapy with dose escalation to biologic target volumes identified with SPECT/CT capromab pendetide. Brachytherapy 2007;6:16-25.
60. Freedland S, et al. Radical Prostatectomy for Clinical Stage T3a Disease. Cancer 2007;109(7):
61. Henry A, et al. Outcomes Following Iodine-125 Monotherapy for localized Prostate Cancer: The results of Leeds 10-year single-center brachytherapy experience. Int J Radiat Oncol Bio Phys 2010;76(1):50-56.
62. Hernandez D, et al. Contemporary Evaluation of the D’Amico risk classification of Prostate Cancer. J Urol 2007;70(5):
63. Hong S, et al. Predictions of Outcomes after Radical Prostatectomy in Patients Diagnosed with Prostate Cancer of Biopsy GS > 8 via Contemporary multi (>12)-core prostate biopsy. BJU Int 2011;108(2):
64. Hull G, et al. Cancer control with radical prostatectomy alone in 1000 consecutive patients. J Urology 2002;167:
65. Khaksar S, et al. Interstitial low dose rate brachytherapy for prostate cancer-a focus on intermediate & high risk disease. Clinical Oncology 2006;18:
66. Khuntia D, et al. Recurrence-free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in prostate specific antigen era. Cancer 2004;100(6):
67. Koontz B, et al. Morbidity and Prostate Specific Antigen Control of External Beam Radiation Therapy plus Low Dose Rate Brachytherapy Boost for Low ,Intermediate and High Risk Prostate Cancer. Brachytherapy 2009;8:
68. Kupelian P, et al. Hypofractionated Intensity-Modulated Radiotherapy (70Gy at 2.5Gy per fraction) for Localized Prostate Cancer: Cleveland Clinic Experience. Int J Radiat Oncol Bio Phys 2007;68(5):
69. Kwok Y, et al. Risk Group stratification in patients undergoing permanent I-125 prostate brachytherapy as monotherapy. Int J Radiat Oncol Bio Phys 2002;53(3):
70. Lederman G, et al. Retrospective Stratification of a Consecutive Cohort of Prostate Cancer Patients Treated with a Combined Regimen of External-beam Radiotherapy and Brachytherapy. Int J Radiat Oncol Bio Phys 2001;49(5):
71. Lee L, et al. Role of Hormonal therapy in the management of intermediate to high risk prostate cancer treated with permanent radioactive seed implantation. Int J Radiat Oncol Bio Phys 2002;52(2):
72. Liauw S, et al. Dose-escalated radiotherapy for hight-risk prostate cancer: outcomes in modern ear with short termandrogen deprivation therapy. Int J Radiat Oncol Bio Phys 2010;77(1):
73. Livsey J, et al. Hypofractionated Conformal Radiotherapy in Carcinoma of the Prostate: five-Year Outcome Analysis. Int J Radiat Oncol Bio Phys 2003;57(5):
74. Nobes J, et al. Biochemical Relapse-Free Survival in 400 Patients Treated with I-125 Prostate Brachytherapy: the Guildford Experience. Prostate Ca & Prostatic Disease 2009;12:61-66.
75. Phan T, et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. J Urology 2007;177:
Prada P, et al. High-dose-rate intensity modulated brachytherapy with external-beam radiotherapy improves local and biochemical control in patients with high risk prostate cancer. Clin Transl Oncol 2008;10:
Sathya J, et al. Randomized Trial comparing Iridium implants plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 2005;23(5):
Stock, R. et al. Combined Modality Treatment in the Management of High Risk Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;59(5):
Stone N, et al. Multicenter Analysis of Effect of High Biologic Effective dose on Biochemical Failure and Survival Outcomes in Patients with Gleason 7-10 Prostate cancer Treated with Permanent Prostate Bracyhhterapy. Int J Radiat Oncol Bio Phys 2009;73(2):
Stone N, et al. Customized dose Prescription for Permanent Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes. Int J Radiat Oncol Bio Phys 2007;69(5):
Yamada Y, et al. Favorable Clinical Outcomes of 3-D Computer Optimized High Dose Rate Prostate Brachytherapy in the management of Localized Prostate cancer. Brachytherapy 2006;5:
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #1)
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #2)
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #3)
Zwahlen D, et al. High Dose Rate Brachytherapy in Combination with Conformal External Beam Radiotherapy in the Treatment of Prostate Cancer. Brachytherapy 2010;9:27-35.
D’Amico A, et al. Biochemical outcomes after Radical Prostatectomy or External Beam Radiation Therapy for patients with clinically localized prostate carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (RP)
D’Amico A, et al. Biochemical outcomes after Radical Prostatectomy or External Beam Radiation Therapy for patients with clinically localized prostate carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (EBRT)
Stokes S, et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation. Int J Radiat Oncol Bio Phys 2000;47(1): (seeds)
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #4)
Higgins G, et al. Outcome Analysis of 300 prostate cancer patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy. IJROBP;65(4):
91. Deutsch, I et al. Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT. Brachytherapy 2010;9:
92. Zapatero, A et al. Long-Term Results After High-Dose Radiotherapy and Adjuvant Hormones in Prostate Cancer: How Curable in High Risk Disease? Int J Radiat Oncol Bio Phys 2011;81(5): . 35 52 63 84
Protons 31 46 73 30 58 27 77
107 86 87 15
HDR 88
102 51
105
EBRT Seeds +
ADT
← Years from Treatment → 23 29 69 49
Robot RP
HIFU
Prostate Cancer Results Study Group
Numbers within symbols refer to references
3/24/2017
BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

30. HIGH RISK RESULTS Weighted
>40 months follow-up or less than 100 patients
Brachy
% PSA Progression Free 92 65 20 81 16 45
109 19 18 80 4 74
108
100
EBRT & ADT 78 38 22
Treatment Success 17 67
EBRT & Seeds 55 40 75 37 72 3 85 43 76 47 54 34 32
Hypo EBRT 91 44 66 9 41 2 79 68 57
104 28 71 13 64 48 10 36 59 42 24 50 56 1 12 8 53 25 61 90
101
110 89
EBRT 62
106 33 21 5 14 70 39 11 26 60
103 83 82 6 7
1st Group References:
1. Bahn, D et al. Targeted Cryoablation of the Prostate:7-year Outcomes in the Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11.
2. Burri, R et al. Young Men have Equivalent Biochemical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer. Int J Radiat Oncol Bio Phys 2010;77(5):
3. Ploussard, G et al. Radical Prostatectomy of High-Risk Prostate Cancer Defined by Preoperative criteria: Oncologic Follow-up in National Multicenter Study in 813 Patients and Assessment of Easy-to-use Prognostic Substratification. Urol 2011;78(3):607-13
4. Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008;72(2):
5. Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:
6. Carver, B et al. Long Term Outcome following Radical Prostatectomy in Men with Clinical T3 Prostate Cancer. J Urology 2006;176:
7. Cohen, J et al. Ten-Year Biochemical Disease Control in Patients with Prostate Cancer Treated with Cryosurgery as Primary Therapy. Urology 2008;71(3):
8. Critz, Fet al. 10-year Disease Survival Rates After Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation Methodology. J Urology 2004;172:
9. Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal High-Dose-Rate Brachytherapy (HDR-BT) Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;58(4):
10. Kollmeier, M et al. Biochemical Outcomes After Prostate Brachytherapy with 5-year Minimal follow-up: Importance of patient Selection and implant Quality. Int J Radiat Oncol Bio Phys 2003;57(3):
11. Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Biol Phys 2003;57(4): (PSA:4-10,GS:2-6,>70 Gy)
12. Kuban, D et al. Long-Term Results of the MD Anderson Randomized Dose-Escalation Trial for Prostate Cancer. Int J Radiat Oncol Bio Phys 2008;70(1):67-74.
13. Sabolch, A et al. Gleason Patter 5 is Greatest Risk Factor for Clinical Failure and Death from Prostate Cancer after Dose-Escalation Radiation Therapy and Hormonal Ablation. Int J Radiat Oncol Bio Phys 2011;81(4):e351-e360.
14. Stenmark, M et al. Continued Benefit to Androgen Deprivation Therapy for Prostate Cancer Patients Treated with Dose-Escalated Radiation Therapy Across Multiple Definitions of High-Risk Disease. Int J Radiat Oncol Bio Phys 2011;81(4):
15. Loeb, S et al. Intermediate-term potency, continence & survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer. Urology 2007;69(6):
16. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3): (EBRT, Seeds, ADT) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
17. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int j Radiat Oncol Bio Phys 2006;65(3): (EBRT & Seeds) Update: Fang, LC et al. High- risk Prostate Cancer with Gleason Score 8-10 and PSA level <15mg/mL Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;81(4):
18. Merrick, G et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy. Urology 2005;66(5):
19. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT & Seeds)
20. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1): (EBRT, Seeds, ADT)
21. Mian, B et al. Outcome of Patients w/ Gleason score 8 or Higher Prostate Cancer following Radical Prostatectomy alone. J Urology 2002;167:
22. Pellizzon, A et al. The Relationship Between the Biochemical Control Outcomes and the Quality of Planning of HDR as a Boost to External Beam Radiotherapy for locally and locally advanced Prostate Cancer using the RTOG-ASTRO Phoenix definition. Int J Med Sci 2008;5:
23. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (EBRT)
24. Potters, L et al. 12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients With Clinically Localized Prostate Cancer. J Urology 2005;173:
25. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1): (RP)
26. Sylvester, J et al. Ten Year Biochemical Relapse Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience. Int J Radiat Oncol Bio Phys 2003;57(4):
Lau, W et al. Radical Prostatectomy for Pathological Gleason 8 or Greater Prostate Cancer: Influence of Concomitant Pathological Variables. J Urol 2002;167:
Stone, N et al. Influence of Pretreatment and Treatment Factors on Intermediate to Long-term Outcome After Prostate Brachytherapy. J Urol 2011;185: Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups. Int J Radiat Oncol Bio Phys 2006;65(4):
30. Ward, J et al. Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer since the advent of PSA testing: 15 year outcome. BJU Int 2005;95:751-6.
31. Zelefsky, M et al. Multi-Institutional Analysis of Long-Term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Bio Phys 2007;67(2):
32. Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176: (81 Gy)
33. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol Bio Phys 2008;71(4): (81 Gy)
34. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol bio Phys 2008;71(4): (86 Gy)
35. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (75 Gy)
36. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166: (81 Gy)
37. Dattoli, M et al. Long-term Outcomes After Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients Having Intermediate and High-Risk Features. Cancer 2007;110(3):
38. Moyad, M et al. Statins, especially Atorvastatin, may Favorable Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):
39. Zelefsky, M et al. Long Term Outcome Following Three dimensional Conformal/IMRT for Clinical Stage T3 Prostate Cancer. Eurr Urol 2008;53:
40. Yoshioka, Y et al. Monotherapeutic High-dose-rate Brachytherapy for Prostate Cancer: Five-year Results of an Extreme Hypofractionation Regimen with 54Gy in Nine Fractions. Int J Radiat Oncol Bio Phys 2011;80(2):
41. Galalae R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer. Strahlenther Onkol 2006;182(3):
42. Demanes, DJ et al. Excellent Results from High Dose Rate Brachytherapy and External Beam Radiation Therapy for Prostate Cancer are Not Imroved by Androgen Deprivation. Amer J Clin Oncol 2009;32(4):
43. Stock, R et al. Outcomes for patients with High-Grade Prostate Cancer Treated with a Combination of Brachytherapy, EBRT and Hormone therapy. BJU Int 2009;104:
44. Stone, N et al. Local Control following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes. Int J Radiat Oncol Bio Phys 2010;76(2):
45. Bittner, N et al. Whole Pelvis Radiotherapy in Combination with Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High Risk Prostate Cancer? Int J Radiat Oncol Bio Phys 2010;76(4):
46. Rubio-Briones, J et al. Metastatic Progression, Cancer Specific Mortality and Need for Secondary Treatments in Patients with Clinically High Risk Prostate Cancer Treated Initially with Radical Prostatectomy. Actas Urologicas Esanolas 2010;34(7):
47. Dattoli, M et al. Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Beam Irradiation and Brachytherapy. J Oncology 2010;2010(Article Id ):6 pages.
48. Menon, M et al. Biochemical Recurrence Following Robot Assisted Radical Prostatectomy: Analysis of 1384 patients with a median 5 year follow-up. Eurr Urol 2010;58:
49. Pierorazio, P et al. Long Term Survival after Radical Prostatectomy for Men with High Gleason Sum in Pathologic Specimen. Urology 2010;76(3):
100. Taira, A et al. Long-term Outcome for Clinically Localized Prostate Cancer Treated with Permanent Interstitial Brachytherapy. Int J Radiat Oncol Bio Phys 2011;79(5):
Deger, S et al. (Germany) High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urology 2005;47:
Magheli A et al. (Johns Hopkins) Importance of Tumor Location in Patients with High Preoperative PSA Levels ( greater than 20 ng/ml treated with Radical Prostatectomy. J Urology 2007;178:
Kupelian P, et al. Improved Biochemical Relapse-Free Survival With Increased Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in 1994 and Int J Radiat Oncol Bio Phys 2005;61(2):
Sylvester, J et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy: Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64.
Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients Treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010;76(5):
Hsu, C et al. Comparing Results After Surgery in Patients with Clinical Unilateral T3a Prostate Cnacer Treated with or without neoadjuvent Androgen-Deprivation Therapy. BJU Int 2006;99:
Roehl, K et al. Cancer Progression and Survival Rates Following Anatomical Radical Prostatectomy in 3,478 Consecutive Patients: Long Term Results. J Urology 2004;172:
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (No ADT)
Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107: (Plus ADT)
110. Kuban, D et al. Long-Term Failure Patterns and Survival in a Randomized Dose-Escalation Trial for Prostate Cancer. Who Dies of Disease? Int J Radiat Oncol Bio Phys 2011;79(5):
2nd Group References:
50. Aizer A, et al. Radical Prostatectomy vs Intensity-Modulated Radiation Therapy in the Management of Localized Prostate Adenocarcinoma. Radiotherapy and Oncology 2009;93:
51. Battermann J, et al. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiotherapy & Oncology 2004;71:23-28.
52. Berglund R, et al. Limited Pelvic Lymph Node Dissection at the Time of Radical Prostatectomy Does Not Affect 5-Year Failure Rates for Low, Intermediate and High Risk Prostate Cancer: Results From CaPSURE. J Urology 2007;177:
53. Beyer D, et al. Relative influence of gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. Brachytherapy 2003;2:77-84.
54. Cahlon O, et al. Ultra high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Bio Phys 2008;71(2):
55. Copp H, et al. Tumor Control Outcomes of Patients Treated With Trimodality Therapy For Locally Advanced Prostate Cancer. Urology 2005;65(6):
56. Crouzet S, et al. Multicentric Oncologic Outcomes of High-Intensity Focused Ultrasound for Localized Prostate Cancer in 803 patients. Eurr Urol 2010;58:
57. Demanes D, et al. High-Dose-Rate Intensity Modulated Brachytherapy With External Beam Radiotherapy for Prostate Cancer: California Endocurietherapy's 10-Year Results. Int J Radiat Oncol Bio Phys 2005;61(5):
Donohue J, et al. Poorly Differentiated Prostate Cancer Treated With Radical Prostatectomy: Long-Term Outcome and Incidence of Pathological Downgrading. J Urology 2006;176(3):
59. Ellis R, et al. Biochemical disease free survival rates following definitive low-dose-rate prostate brachytherapy with dose escalation to biologic target volumes identified with SPECT/CT capromab pendetide. Brachytherapy 2007;6:16-25.
60. Freedland S, et al. Radical Prostatectomy for Clinical Stage T3a Disease. Cancer 2007;109(7):
61. Henry A, et al. Outcomes Following Iodine-125 Monotherapy for localized Prostate Cancer: The results of Leeds 10-year single-center brachytherapy experience. Int J Radiat Oncol Bio Phys 2010;76(1):50-56.
62. Hernandez D, et al. Contemporary Evaluation of the D’Amico risk classification of Prostate Cancer. J Urol 2007;70(5):
63. Hong S, et al. Predictions of Outcomes after Radical Prostatectomy in Patients Diagnosed with Prostate Cancer of Biopsy GS > 8 via Contemporary multi (>12)-core prostate biopsy. BJU Int 2011;108(2):
64. Hull G, et al. Cancer control with radical prostatectomy alone in 1000 consecutive patients. J Urology 2002;167:
65. Khaksar S, et al. Interstitial low dose rate brachytherapy for prostate cancer-a focus on intermediate & high risk disease. Clinical Oncology 2006;18:
66. Khuntia D, et al. Recurrence-free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in prostate specific antigen era. Cancer 2004;100(6):
67. Koontz B, et al. Morbidity and Prostate Specific Antigen Control of External Beam Radiation Therapy plus Low Dose Rate Brachytherapy Boost for Low ,Intermediate and High Risk Prostate Cancer. Brachytherapy 2009;8:
68. Kupelian P, et al. Hypofractionated Intensity-Modulated Radiotherapy (70Gy at 2.5Gy per fraction) for Localized Prostate Cancer: Cleveland Clinic Experience. Int J Radiat Oncol Bio Phys 2007;68(5):
69. Kwok Y, et al. Risk Group stratification in patients undergoing permanent I-125 prostate brachytherapy as monotherapy. Int J Radiat Oncol Bio Phys 2002;53(3):
70. Lederman G, et al. Retrospective Stratification of a Consecutive Cohort of Prostate Cancer Patients Treated with a Combined Regimen of External-beam Radiotherapy and Brachytherapy. Int J Radiat Oncol Bio Phys 2001;49(5):
71. Lee L, et al. Role of Hormonal therapy in the management of intermediate to high risk prostate cancer treated with permanent radioactive seed implantation. Int J Radiat Oncol Bio Phys 2002;52(2):
72. Liauw S, et al. Dose-escalated radiotherapy for hight-risk prostate cancer: outcomes in modern ear with short termandrogen deprivation therapy. Int J Radiat Oncol Bio Phys 2010;77(1):
73. Livsey J, et al. Hypofractionated Conformal Radiotherapy in Carcinoma of the Prostate: five-Year Outcome Analysis. Int J Radiat Oncol Bio Phys 2003;57(5):
74. Nobes J, et al. Biochemical Relapse-Free Survival in 400 Patients Treated with I-125 Prostate Brachytherapy: the Guildford Experience. Prostate Ca & Prostatic Disease 2009;12:61-66.
75. Phan T, et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. J Urology 2007;177:
Prada P, et al. High-dose-rate intensity modulated brachytherapy with external-beam radiotherapy improves local and biochemical control in patients with high risk prostate cancer. Clin Transl Oncol 2008;10:
Sathya J, et al. Randomized Trial comparing Iridium implants plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 2005;23(5):
Stock, R. et al. Combined Modality Treatment in the Management of High Risk Prostate Cancer. Int J Radiat Oncol Bio Phys 2004;59(5):
Stone N, et al. Multicenter Analysis of Effect of High Biologic Effective dose on Biochemical Failure and Survival Outcomes in Patients with Gleason 7-10 Prostate cancer Treated with Permanent Prostate Bracyhhterapy. Int J Radiat Oncol Bio Phys 2009;73(2):
Stone N, et al. Customized dose Prescription for Permanent Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes. Int J Radiat Oncol Bio Phys 2007;69(5):
Yamada Y, et al. Favorable Clinical Outcomes of 3-D Computer Optimized High Dose Rate Prostate Brachytherapy in the management of Localized Prostate cancer. Brachytherapy 2006;5:
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #1)
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #2)
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #3)
Zwahlen D, et al. High Dose Rate Brachytherapy in Combination with Conformal External Beam Radiotherapy in the Treatment of Prostate Cancer. Brachytherapy 2010;9:27-35.
D’Amico A, et al. Biochemical outcomes after Radical Prostatectomy or External Beam Radiation Therapy for patients with clinically localized prostate carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (RP)
D’Amico A, et al. Biochemical outcomes after Radical Prostatectomy or External Beam Radiation Therapy for patients with clinically localized prostate carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2): (EBRT)
Stokes S, et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation. Int J Radiat Oncol Bio Phys 2000;47(1): (seeds)
Yossepowitch O, et al. Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178: (Def. #4)
Higgins G, et al. Outcome Analysis of 300 prostate cancer patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy. IJROBP;65(4):
91. Deutsch, I et al. Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT. Brachytherapy 2010;9:
92. Zapatero, A et al. Long-Term Results After High-Dose Radiotherapy and Adjuvant Hormones in Prostate Cancer: How Curable in High Risk Disease? Int J Radiat Oncol Bio Phys 2011;81(5): 35 52 63 84
Protons 31 30 77 46 73 58 27
107
HDR 86 87 88
102 15 51
105
EBRT Seeds +
ADT
← Years from Treatment → 23 29
Surgery 69 49
Robot RP
HIFU
Prostate Cancer Results Study Group
Numbers within symbols refer to references
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BJU Int, 2012, Vol. 109(Supp 1)
Prostate Cancer Center of Seattle

31. OBSERVATIONS
For most low risk patients, most therapies will be successful.
There appears to be a higher cancer control success rate for Brachy over EBRT and Surgery for all groups. Patients are encouraged to look at graphs and determine for themselves
Serious side effect rates must be considered for any treatment
Relaxing the report selection criteria doesn’t seem to impact the results substantially
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32. Slide Symbols & Abbreviations
= Seeds alone
= EBRT & Seeds
= Surgery = Standard Radical Prostatectomy
= “Robot” =Robotic Prostatectomy
= “HIFU” = High Frequency Ultrasound
= “HDR”= High Dose Rate Brachytherapy +/-EBRT
= EBRT alone
= Hypo EBRT
= Protons
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33. Slide Symbols & Abbreviations (cont.)
= “CRYO” Cryo Therapy
= EBRT, Seeds, & ADT
= Seeds & ADT
= EBRT & ADT
= “Brachy” = all seed implant treatments
= all Surgery treatments
= all EBRT treatments
= all EBRT & Seeds
= all EBRT, Seeds & ADT +
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34. Risk Group Definitions
Low Risk
Stage: T1 or T2a,b Gleason Sum < PSA < 10 ng/ml
Intermediate Risk
Stage T1 or T Stage T1-2
Gleason Score 7 or Gleason 6
PSA < PSA 10-20
High Risk
Stage T2c or T3
Gleason score ≥ 8
PSA > 20 ng/mL
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35. For More Information Peter Grimm, DO Lisa Grimm, Research Coordinator
Lisa Grimm, Research Coordinator
Or ProstateCancerTC.com
Or contact PCRSG member
Prostate Cancer Treatment Center website
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