Primary pattern 3 patients continued to exhibit superior bPFS in the subset of patients with either PSA ≤10 or PPC >50%. Statistical significance was not maintained among patients with PSA
>10 or PPC VX-809 clinical trial ≤50%. This likely relates to a loss of statistical power within these subsets, but the possibility of an unexpected relationship between PSA/PPC and primary Gleason pattern cannot be excluded. Overall, this Gleason 7 patient population treated with LDR interstitial brachytherapy did exceptionally well. Even among primary pattern 4 patients, long-term CSS was 96.9% and bPFS was 93.1%. These results compare favorably with published prostatectomy data, where bPFS rates in the range Belnacasan chemical structure of 38–48% have been reported in patients with comparable disease features (15). This marked difference in biochemical outcome between the two treatment modalities may be because of the inability of prostatectomy to effectively eradicate subclinical extracapsular disease. Although the difference in bPFS between primary Gleason 3 and 4 was statistically significant in this study, the magnitude of this difference was relatively
small. It is unlikely that further intensification of local therapy would have mitigated the differences in outcome between the primary Gleason 3 and 4 given the relatively high biologic doses that were used in this study (18). A slightly higher incidence of subclinical metastatic disease among primary Gleason 4 patients may provide an explanation for the observed differences. Gleason 7 prostate cancer patients treated with LDR interstitial brachytherapy have an excellent long-term outcome. There was a small but statistically significant advantage in bPFS and a trend toward improved CSS in patients with a primary Gleason pattern of 3. “
“Prostate brachytherapy is widely practiced throughout the United States Mirabegron and is used as an effective first-line
therapy for the management of patients with clinically localized prostate cancer. Postprocedure evaluation of the quality of the implantation and the adequacy of the dose delivery to the prostate are routinely performed and considered standard of care. This quality assurance (QA) dosimetric assessment is based on the coordinates of the implanted seeds within the prostate gland as noted on a CT scan obtained 0–30 days after the procedure and accounts as well for the strength, number of the radioactive seeds, and their juxtaposition to the surrounding normal tissues. Dosimetric parameters measured include the radiation dose delivered to the prostate and the percentage of the prescription dose (PD) exposed to rectum and urethra. There have been several single- and multiinstitutional series that have reported dosimetric outcomes after low-dose-rate permanent interstitial prostate brachytherapy [1], [2], [3], [4] and [5].
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