{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:52:13Z","timestamp":1787014333594,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the prognostic impact of Grade Group (GG) 5 following permanent seed implantation brachytherapy\u2010based trimodality therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 352 men with National Comprehensive Cancer Network high\u2010risk prostate cancer treated with trimodality therapy (low\u2010dose\u2010rate brachytherapy, external beam radiation therapy, and androgen deprivation therapy [ADT]) between 2003 and 2019. Staging included computed tomography, magnetic resonance imaging, and bone scintigraphy. Endpoints were biochemical recurrence (BCR; Phoenix definition), overall survival (OS), and cancer\u2010specific survival (CSS). Survival outcomes were assessed using the Kaplan\u2013Meier and log\u2010rank tests. Multivariable Cox proportional hazards models, adjusting for prostate\u2010specific antigen, clinical stage, duration of ADT, and biologically effective dose (BED), evaluated the association between GG5 and BCR. Clinical recurrence patterns post\u2010BCR were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median follow\u2010up was 8.2\u2009years (interquartile range [IQR] 5.4\u201310.0); median BED was 214\u2009Gy (IQR 207\u2013222). Among three study groups (GG1\u20133, GG4, and GG5), GG5 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009106) exhibited significantly lower BCR\u2010free survival (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) and CSS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045), while OS was comparable (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.3). GG5 remained an independent risk factor for BCR after the adjustment (vs. GG1\u20134, hazard ratio 2.78, 95% confidence interval 1.60\u20134.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). GG5 recurrences predominantly involved the pelvic nodes or bone, whereas local and visceral metastases were infrequent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated that GG5 is an independent predictor of BCR and cancer\u2010specific mortality after trimodality therapy. Despite high BED, the propensity for nodal and bone metastases suggests the need for intensified staging and systemic therapy to optimize outcomes for GG5 disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70574","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:12:46Z","timestamp":1784023966000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic Impact and Metastasis Propensity of Grade Group 5 Prostate Cancer Following Permanent Seed Implantation Brachytherapy\u2010Based Trimodality Therapy: Implications for Intensified Staging and Systemic Therapy Optimization"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3633-5987","authenticated-orcid":false,"given":"Tomomasa","family":"Matsuo","sequence":"first","affiliation":[{"name":"Department of Urology National Hospital Organization Tokyo Medical Center  Tokyo 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