{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T19:13:10Z","timestamp":1762542790589,"version":"build-2065373602"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,2,16]],"date-time":"2018-02-16T00:00:00Z","timestamp":1518739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007277","name":"Icahn School of Medicine at Mount Sinai","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007277","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2018,5]]},"abstract":"\n Objective<\/jats:title>\n \n To evaluate the cancer control outcomes and long\u2010term treatment\u2010related morbidity of brachytherapy as well as combination brachytherapy and external beam radiation therapy (\n EBRT<\/jats:styled-content>\n ) in patients with intermediate\u2010risk prostate cancer.\n <\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n \n A retrospective review was conducted in a prospectively collected database of patients with intermediate\u2010risk prostate cancer who were treated either with brachytherapy or brachytherapy and\n EBRT<\/jats:styled-content>\n , with or without androgen deprivation therapy (\n ADT<\/jats:styled-content>\n ), in the period 1990\u20132014. Urinary and erectile dysfunction symptoms were measured using the International Prostate Symptom Score (\n IPSS<\/jats:styled-content>\n ), the Mount Sinai erectile function scale and the Sexual Health Inventory for Men (\n SHIM<\/jats:styled-content>\n ). Cancer control endpoints included biochemical failure and development of distant metastases. All statistical analyses were carried out using the Statistical Package for Social Science (\n SPSS<\/jats:styled-content>\n ). Survival curves were calculated using Kaplan\u2013Meier actuarial methods and compared using log\u2010rank tests. Cox regression multivariate analyses were used to test the effect of multiple variables on treatment outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 902 patients were identified, with a median follow\u2010up of 91 months. Of these, 390 received brachytherapy and 512 received combination therapy with\n EBRT<\/jats:styled-content>\n . In patients with one intermediate\u2010risk factor, the addition of\n EBRT<\/jats:styled-content>\n did not significantly affect freedom from biochemical failure or distant metastases. Among patients with two or three intermediate\u2010risk factors, added\n EBRT<\/jats:styled-content>\n did not improve freedom from biochemical failure. Significant differences in late toxicity between patients treated with brachytherapy vs combination brachytherapy and\n EBRT<\/jats:styled-content>\n were identified including urge incontinence (\n P<\/jats:italic>\n < 0.001), haematuria (\n P<\/jats:italic>\n < 0.001), dysuria (\n P<\/jats:italic>\n < 0.001), and change in quality\u2010of\u2010life\n IPSS<\/jats:styled-content>\n (\n P<\/jats:italic>\n = 0.002). These symptoms were reported by patients at any point during treatment follow\u2010up. Analysis of patients who were potent before treatment using actuarial methods showed that patients receiving combination therapy more frequently experienced loss of potency, as measured by the Mount Sinai erectile function scale (\n P<\/jats:italic>\n = 0.040).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Brachytherapy monotherapy results in equal biochemical and distant control in both patients with one and more than one intermediate\u2010risk features. While no significant benefit was shown, we believe that the addition of\n EBRT<\/jats:styled-content>\n may prevent recurrence in patients with multiple intermediate\u2010risk features and should be considered.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.14128","type":"journal-article","created":{"date-parts":[[2018,1,10]],"date-time":"2018-01-10T12:25:44Z","timestamp":1515587144000},"page":"774-780","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Outcomes and toxicities in patients with intermediate\u2010risk prostate cancer treated with brachytherapy alone or brachytherapy and supplemental external beam radiation therapy"],"prefix":"10.1111","volume":"121","author":[{"given":"Emily","family":"Schlussel Markovic","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Icahn School of Medicine at Mount Sinai New York NY 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