PURPOSE To assess the effectiveness of low-dose-rate (LDR) brachytherapy in patients with localized prostate cancer and to compare the outcome with predictions from Kattan and Partin nomograms at 60 months after seed implantation. MATERIAL AND METHODS One thousand, one hundred and eighty-seven patients with localized prostate cancer at low-, intermediate-, or high-risk of progression received LDR brachytherapy using iodine-125 seeds with curative intent, applied as monotherapy or in combination with external beam radiation therapy (EBRT), and/or androgen deprivation therapy (ADT). At 60 months after seed implantation, data of 1,064 patients (1,058 alive + 6 who died of prostate cancer) were analyzed for biochemical progression-free survival (bPFS) based on prostate-specific antigen (PSA) levels using the Phoenix definition. Five-year bPFS probabilities were determined for various risk group classifications (d'Amico, Mt. Sinai, MSKCC/Seattle, NCCN). Outcomes were also compared to patient-individualized nomogram predictions of 5-year bPFS (Kattan 2002) and probability of organ-confined disease (Kattan 2002, Partin 2007). RESULTS Overall, 93.3% (993/1,064) of the patients were free of biochemical progression within 5 years, while the average 5-year bPFS probability according to the Kattan nomogram was significantly lower (85%, p < 0.001). Outcomes were significantly better than Kattan nomogram predictions in the subgroup of patients with monotherapy as well as in patients additionally treated with EBRT. Comparison of the overall outcome with nomogram predictions for organ-confined disease (Kattan nomogram: 50%; Partin nomogram: 65%) revealed a significant probability of LDR brachytherapy to destroy periprostatic tumor spread (p < 0.001) in all risk group constellations, even in high-risk patients. CONCLUSIONS The results indicate high effectiveness of LDR brachytherapy in all risk groups, significantly better than predicted with the Kattan nomogram in most subgroups. The significant superiority of LDR brachytherapy compared to nomogram predictions of organ-confined disease suggests that LDR brachytherapy effectively controls both intra- and periprostatic disease.

中文翻译：

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低剂量率近距离放射治疗的五年有效性：与非转移性前列腺癌患者的列线图预测进行比较，显着控制前列腺内和前列腺周围疾病。

目的 评估低剂量率 (LDR) 近距离放射治疗对局部前列腺癌患者的有效性，并将结果与​​种子植入后 60 个月时 Kattan 和 Partin 列线图的预测结果进行比较。材料和方法 10187 名处于低、中或高进展风险的局限性前列腺癌患者接受了 LDR 近距离放射治疗，使用具有治愈目的的碘 125 种子，作为单一疗法或与外部疗法联合使用束放射疗法 (EBRT) 和/或雄激素剥夺疗法 (ADT)。在种子植入后 60 个月，使用 Phoenix 定义根据前列腺特异性抗原 (PSA) 水平分析了 1,064 名患者（1,058 名存活 + 6 名死于前列腺癌）的生化无进展生存期 (bPFS)。确定了各种风险组分类（d'Amico、Mt. Sinai、MSKCC/Seattle、NCCN）的五年 bPFS 概率。结果还与 5 年 bPFS (Kattan 2002) 和器官局限性疾病概率 (Kattan 2002, Partin 2007) 的患者个体化列线图预测进行了比较。结果 总体而言，93.3% (993/1,064) 的患者在 5 年内没有生化进展，而根据 Kattan 列线图的平均 5 年 bPFS 概率显着降低 (85%, p < 0.001)。在单药治疗患者亚组以及额外接受 EBRT 治疗的患者中，结果明显优于 Kattan 列线图预测。将总体结果与器官局限疾病的列线图预测进行比较（Kattan 列线图：50%；Partin 列线图：65%）显示在所有风险组群中，即使在高风险患者中，LDR 近距离放射治疗破坏前列腺周围肿瘤扩散的可能性很大（p < 0.001）。结论 结果表明，LDR 近距离治疗在所有风险组中均具有很高的有效性，在大多数亚组中明显优于 Kattan 列线图的预测。与器官局限疾病的列线图预测相比，LDR 近距离放射治疗的显着优势表明 LDR 近距离放射治疗有效地控制了前列腺内和前列腺周围疾病。在大多数亚组中，显着优于 Kattan 列线图的预测。与器官局限疾病的列线图预测相比，LDR 近距离放射治疗的显着优势表明 LDR 近距离放射治疗有效地控制了前列腺内和前列腺周围疾病。在大多数亚组中，显着优于 Kattan 列线图的预测。与器官局限疾病的列线图预测相比，LDR 近距离放射治疗的显着优势表明 LDR 近距离放射治疗有效地控制了前列腺内和前列腺周围疾病。