Prostate brachytherapy Outcomes from Gleason 7, intermediate risk, localized prostate cancer treated with Iodine-125 monotherapy over 10 years Nicholas P. Munro d, * , Bashar Al-Qaisieh b , Peter Bownes b , Jonathan Smith c , Brendan Carey c , David Bottomley a , Dan Ash a , Ann M. Henry a a Department of Clinical Oncology; b Department of Medical Physics; c Department of Clinical Radiology; and d Department of Urology, St James’s Institute of Oncology, St James’s University Hospital, Leeds, UK article info Article history: Received 6 February 2009 Received in revised form 27 February 2010 Accepted 7 March 2010 Available online 31 March 2010 Keywords: Brachytherapy Prostate cancer Gleason score 7 Survival abstract Background and purpose: The effect of predominating Gleason grade (3 + 4 versus 4 + 3) in Gleason sum score (GS) 7 prostate cancer (PCa) on brachytherapy outcomes is unclear. The 10 year experience of per- manent brachytherapy monotherapy at a single UK centre for GS 7, intermediate risk (Memorial Sloan- Kettering model), PSA 6 10 ng/ml, localised PCa is reported. Materials and methods: Between 1995 and 2004, the outcomes of 187 patients with GS 7 PCa (PSA 6 10 ng/ml) were analysed from a cohort of 1298 men treated with permanent Iodine-125 prostate brachytherapy, including PSA relapse-free survival (PSA-RFS). Results: Median follow-up was 5.0 years (range 2.0–10.1 years). One patient has died of PCa. At 10 years, PSA-RFS was 82.4%/78% (ASTRO consensus and nadir +2 definitions). For GS 3 + 4, 5 year PSA-RFS was 86.7%/87.9% and for GS 4 + 3: 85.2%/96.6% respectively, with no significant difference between groups. Five year PSA-RFS (ASTRO) of 92.6% was seen for D 90 P 140 Gy (50% total), compared with 77.0% below 140 Gy (p = 0.08). Conclusions: Iodine-125 brachytherapy monotherapy achieved good rates of medium term biochemical control in GS 7, intermediate risk localised PCa patients. There was a trend to improved outcomes in men with a D90 in excess of 140 Gy. Ó 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 96 (2010) 34–37 We have previously reported upon the outcomes of 1298 men treated with I-125 monotherapy for localised prostate cancer over 11 years [1]. We present a further analysis of GS 7, intermediate risk (Memorial Sloan-Kettering model), PSA 6 10 ng/ml, localised PCa. Tumour grade (GS) is a powerful prognostic variable in the treatment of localized PCa, although the effect of predominating Gleason grade (3 + 4 versus 4 + 3) upon outcomes of brachytherapy treatment for GS 7 PCa is unclear. The few studies that have exam- ined this correlation have produced conflicting results [2–4]. Com- parisons between studies are limited by differences in the definition of relapse-free survival. Our previous study demonstrated a correlation between D 90 (dose received by 90% of the prostate) and biochemical control, with a significant improvement in PSA relapse-free survival (approximately 10%) in those patients with D 90 P 140 Gy [1]. We investigated if this correlation was maintained in this cohort of intermediate risk patients. The present study aims to review the 10 year experience of per- manent brachytherapy monotherapy at a single UK centre for GS 7, intermediate risk (MSK model), PSA 6 10 ng/ml, localised PCa. In particular we aim to assess the impact upon predominating Glea- son grade and D 90 upon outcome. Materials and methods Between March 1995 and September 2004, 1298 men were treated with permanent prostate brachytherapy Iodine-125 monotherapy at a single cancer centre, of which 203 were iden- tified as T1c-2 GS7 PCa with a PSA 6 10.0 ng/ml. All biopsy pathology specimens from referring institutions were reviewed by a single specialist uropathologist at our institution. Complete data were available for 187 patients, who were subjected to analyses. Details of the brachytherapy techniques used have been previ- ously reported [1]. All patients were treated by implantation with 125 Iodine seeds as monotherapy. Planning objectives are a minimum peripheral dose of 145 Gy to the prostate capsule plus a margin of 2–5 mms, a Vp100 (prostate volume covered by 100% of the prescription dose) in excess of 99%, and a D90 (dose 0167-8140/$ - see front matter Ó 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.radonc.2010.03.004 * Corresponding author. Address: 48 Franklin road, Harrogate, North Yorkshire, HG1 5EE, UK. E-mail address: nic@munron.plus.com (N.P. Munro). Radiotherapy and Oncology 96 (2010) 34–37 Contents lists available at ScienceDirect Radiotherapy and Oncology journal homepage: www.thegreenjournal.com