{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:29:40Z","timestamp":1786357780889,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Prostate cancer patients with intermediate disease risk [Gleason score (GS)7] can be divided into two groups: GS = 7(3 + 4) (ISUP 2) (favorable disease risk) and GS = 7(4 + 3) (ISUP 3) (unfavorable disease risk). Low-dose-rate brachytherapy (LDR-BT) is an effective treatment for low- and intermediate-disease-risk patients. Objectives: The main goal of this study was to evaluate the effectiveness of LDR-BT monotherapy in prostate cancer patients classified as ISUP 3 when compared with ISUP 2 patients. Methods: This was a retrospective study that evaluated prostate cancer patients classified as ISUP 2 and ISUP 3 followed up at the Center for the Treatment of Urological Diseases, Portugal, who underwent LDR-BT. Overall survival (OS), biochemical recurrence-free survival (BRFS), bone metastasis and complications post-LDR-BT treatment were evaluated. Results: A total of 602 patients classified with GS = 7 (481\/602 ISUP 2 and 121\/602 ISUP 3) treated with LDR-BT were recruited. High OS rates and a reduced frequency of complications were described in both groups of patients. ISUP 3 patients had a lower BRFS rate, a higher risk of biochemical recurrence, and developed more bone metastasis in a shorter period when compared with ISUP 2 patients. No significant differences were detected in prostate-cancer-specific mortality between groups. Conclusions: LDR-BT monotherapy is a safe and effective treatment for prostate cancer patients with favorable and unfavorable intermediate disease risk, with similar OS rates and reduced complications.<\/jats:p>","DOI":"10.3390\/cancers18162546","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:00:43Z","timestamp":1786118443000},"page":"2546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Defying the Unfavorable Risk: The Efficacy of LDR Brachytherapy Monotherapy in Gleason 7 Prostate Cancer: A 16-Year Single-Center Retrospective Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3304-3803","authenticated-orcid":false,"given":"Carlos","family":"Raba\u00e7a","sequence":"first","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Portuguese Institute of Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3542-1145","authenticated-orcid":false,"given":"Domingos","family":"Roda","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Joaquim Chaves Sa\u00fade, Rua An\u00edbal Bettencourt, n.\u00b0 3, Edif\u00edcio CORE, 2790-225 Carnaxide, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Vieira","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Joaquim Chaves Sa\u00fade, Rua An\u00edbal Bettencourt, n.\u00b0 3, Edif\u00edcio CORE, 2790-225 Carnaxide, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Pereira","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Portuguese Institute of Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal"},{"name":"Faculty of Health Sciences, University Beira Interior, Av. Infante D. Henrique, 6200-506 Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Godinho","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Portuguese Institute of Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal"},{"name":"Faculty of Health Sciences, University Beira Interior, Av. Infante D. Henrique, 6200-506 Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rio","family":"Louren\u00e7o","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Portuguese Institute of Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal"},{"name":"Faculty of Health Sciences, University Beira Interior, Av. Infante D. Henrique, 6200-506 Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1362-1263","authenticated-orcid":false,"given":"Jos\u00e9 Alberto","family":"Pereira","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Portuguese Institute of Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarida","family":"Regencio","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Portuguese Institute of Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Macedo","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"},{"name":"Hospital Lus\u00edadas, Av. dos Hospitais Civis de Lisboa 8, 2724-002 Amadora, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7202-8059","authenticated-orcid":false,"given":"Rui Caetano","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Institute of Histology and Embryology, Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amilcar","family":"Sismeiro","sequence":"additional","affiliation":[{"name":"Center for the Treatment of Urological Diseases, R. Dom Manuel I n.\u00b0 8, Est\u00e1dio Cidade de Coimbra, 3030-320 Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0820-9568","authenticated-orcid":false,"given":"Anabela Mota","family":"Pinto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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