High dose-rate brachytherapy boost for intermediate risk prostate cancer: Long-term outcomes of two different treatment schedules and early biochemical predictors of success

Radiother Oncol. 2015 Apr;115(1):84-9. doi: 10.1016/j.radonc.2015.02.023. Epub 2015 Mar 11.


Background and purpose: To report long-term cancer control rates following high dose-rate (HDR) brachytherapy boost for intermediate risk prostate cancer and explore early biochemical predictors of success.

Material and methods: Results of two sequential phase II trials are updated and compared: (1) Single 15 Gy HDR-boost followed by external beam radiotherapy (EBRT) 37.5 Gy/15fractions, (2) Two HDR fractions of 10 Gy followed by EBRT 45 Gy/25fractions. Patients were followed prospectively for clinical and biochemical outcomes. Nadir PSA (nPSA) and PSA at 3-years were analyzed as continuous variables, and ROC analysis was used to identify the optimal cutoff values. Kaplan-Meier bDFS curves were generated and the log-rank test used to compare different groups

Results: 183 patients were accrued; 123 to the single fraction trial and 60 to the standard fractionation trial, with a median follow-up of 74 months and 99 months, respectively. The 5-year biochemical relapse-free survival was 97.4% and 92.7%, respectively (p=0.995). Median nPSA was 0.08 ng/ml. Failure to achieve a nPSA <0.4 ng/ml was associated with a significantly higher rate of biochemical relapse (5-year bDFS: 100% vs. 72%; p<0.0001).

Conclusion: HDR boost with single fraction 15 Gy provides durable long-term biochemical disease-free survival. PSA nadir <0.4 ng/ml is associated with very low risk of biochemical failure.

Keywords: Brachytherapy; HDR; PSA nadir; Prostate cancer; Single fraction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brachytherapy / methods*
  • Disease-Free Survival
  • Dose Fractionation, Radiation
  • Humans
  • Male
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / radiotherapy*
  • ROC Curve
  • Radiation Dosage
  • Risk Factors
  • Treatment Outcome


  • Prostate-Specific Antigen