{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:21:09Z","timestamp":1760955669180,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2016,11,10]],"date-time":"2016-11-10T00:00:00Z","timestamp":1478736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>High-dose-rate brachytherapy (HDR-BT) with external beam radiation therapy (EBRT) is a common treatment option for locally advanced prostate cancer (PCa). Seventy-nine male patients (median age 71 years, range 50 to 79) with high-risk PCa underwent HDR-BT following EBRT between December 2009 and January 2016 with a median follow-up of 21 months. HDR-BT was administered in two treatment sessions (one week interval) with 9 Gy per fraction using a planning system and the Ir192 treatment unit GammaMed Plus iX. EBRT was performed with CT-based 3D-conformal treatment planning with a total dose administration of 50.4 Gy with 1.8 Gy per fraction and five fractions per week. Follow-up for all patients was organized one, three, and five years after radiation therapy to evaluate early and late toxicity side effects, metastases, local recurrence, and prostate-specific antigen (PSA) value measured in ng\/mL. The evaluated data included age, PSA at time of diagnosis, PSA density, BMI (body mass index), Gleason score, D\u2019Amico risk classification for PCa, digital rectal examination (DRE), PSA value after one\/three\/five year(s) follow-up (FU), time of follow-up, TNM classification, prostate volume, and early toxicity rates. Early toxicity rates were 8.86% for gastrointestinal, and 6.33% for genitourinary side effects. Of all treated patients, 84.81% had no side effects. All reported complications in early toxicity were grade 1. PSA density at time of diagnosis (p = 0.009), PSA on date of first HDR-BT (p = 0.033), and PSA on date of first follow-up after one year (p = 0.025) have statistical significance on a higher risk to get a local recurrence during follow-up. HDR-BT in combination with additional EBRT in the presented design for high-risk PCa results in high biochemical control rates with minimal side-effects. PSA is a negative predictive biomarker for local recurrence during follow-up. A longer follow-up is needed to assess long-term outcome and toxicities.<\/jats:p>","DOI":"10.3390\/ijms17111879","type":"journal-article","created":{"date-parts":[[2016,11,10]],"date-time":"2016-11-10T10:51:39Z","timestamp":1478775099000},"page":"1879","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prostate Specific Antigen (PSA) as Predicting Marker for Clinical Outcome and Evaluation of Early Toxicity Rate after High-Dose Rate Brachytherapy (HDR-BT) in Combination with Additional External Beam Radiation Therapy (EBRT) for High Risk Prostate Cancer"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0787-2763","authenticated-orcid":false,"given":"Thorsten","family":"Ecke","sequence":"first","affiliation":[{"name":"Department of Urology, HELIOS Hospital, D-15526 Bad Saarow, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Juan","family":"Huang-Tiel","sequence":"additional","affiliation":[{"name":"Department of Neurology\/Emergency Unit, Vivantes Hospital Spandau, D-13585 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Golka","sequence":"additional","affiliation":[{"name":"Leibniz Research Centre for Working Environment and Human Factors IfADo, D-44139 Dortmund, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Selinski","sequence":"additional","affiliation":[{"name":"Leibniz Research Centre for Working Environment and Human Factors IfADo, D-44139 Dortmund, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berit","family":"Geis","sequence":"additional","affiliation":[{"name":"Leibniz Research Centre for Working Environment and Human Factors IfADo, D-44139 Dortmund, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Koswig","sequence":"additional","affiliation":[{"name":"Department of Radio-Oncology, HELIOS Hospital, D-15525 Bad Saarow, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrin","family":"Bathe","sequence":"additional","affiliation":[{"name":"Department of Radio-Oncology, HELIOS Hospital, D-15525 Bad Saarow, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen","family":"Hallmann","sequence":"additional","affiliation":[{"name":"Department of Urology, HELIOS Hospital, D-15526 Bad Saarow, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Gerullis","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences Carl von Ossietzky, University Oldenburg, D-26133 Oldenburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2016,11,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.eururo.2013.09.046","article-title":"Eau guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent-update 2013","volume":"65","author":"Heidenreich","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1200\/JCO.2005.06.154","article-title":"Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate","volume":"23","author":"Sathya","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.radonc.2012.01.007","article-title":"Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer","volume":"103","author":"Hoskin","year":"2012","journal-title":"Radiother. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1200\/JCO.2010.31.7305","article-title":"Comparison of health-related quality of life 5 years after spirit: Surgical prostatectomy versus interstitial radiation intervention trial","volume":"29","author":"Crook","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.radonc.2007.04.011","article-title":"High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: Initial results of a randomised phase three trial","volume":"84","author":"Hoskin","year":"2007","journal-title":"Radiother. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.brachy.2013.11.002","article-title":"The 15-year outcomes of high-dose-rate brachytherapy for radical dose escalation in patients with prostate cancer\u2014A benchmark for high-tech external beam radiotherapy alone?","volume":"13","author":"Galalae","year":"2014","journal-title":"Brachytherapy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1080\/02841860600710913","article-title":"3-D conformal treatment of prostate cancer to 74 Gy vs. High-dose-rate brachytherapy boost: A cross-sectional quality-of-life survey","volume":"45","author":"Vordermark","year":"2006","journal-title":"Acta Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.brachy.2009.04.007","article-title":"High-dose-rate brachytherapy in combination with conformal external beam radiotherapy in the treatment of prostate cancer","volume":"9","author":"Zwahlen","year":"2010","journal-title":"Brachytherapy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.ijrobp.2010.09.021","article-title":"High-dose-rate brachytherapy boost for prostate cancer: Comparison of two different fractionation schemes","volume":"82","author":"Kaprealian","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.brachy.2009.08.003","article-title":"Preliminary results in prostate cancer patients treated with high-dose-rate brachytherapy and intensity modulated radiation therapy (IMRT) vs. IMRT alone","volume":"9","author":"Wilder","year":"2010","journal-title":"Brachytherapy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s00066-014-0794-y","article-title":"Additional androgen deprivation makes the difference: Biochemical recurrence-free survival in prostate cancer patients after hdr brachytherapy and external beam radiotherapy","volume":"191","author":"Schiffmann","year":"2015","journal-title":"Strahlenther. Onkol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8198","DOI":"10.1200\/JCO.2005.03.1468","article-title":"Role of salvage radical prostatectomy for recurrent prostate cancer after radiation therapy","volume":"23","author":"Stephenson","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S0360-3016(01)01557-7","article-title":"Patterns and fate of PSA bouncing following 3D-CRT","volume":"50","author":"Hanlon","year":"2001","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1016\/S0022-5347(05)64282-6","article-title":"Prostate specific antigen bounce phenomenon after external beam radiation for clinically localized prostate cancer","volume":"168","author":"Rosser","year":"2002","journal-title":"J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S0167-8140(02)00408-5","article-title":"Results of high dose rate afterloading brachytherapy boost to conventional external beam radiation therapy for initial and locally advanced prostate cancer","volume":"66","author":"Pellizzon","year":"2003","journal-title":"Radiother. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.ijrobp.2006.04.029","article-title":"Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO phoenix consensus conference","volume":"65","author":"Roach","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.brachy.2011.09.008","article-title":"American brachytherapy society consensus guidelines for high-dose-rate prostate brachytherapy","volume":"11","author":"Yamada","year":"2012","journal-title":"Brachytherapy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.radonc.2013.05.002","article-title":"GEC\/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: An update","volume":"107","author":"Hoskin","year":"2013","journal-title":"Radiother. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/j.ijrobp.2011.04.031","article-title":"High-dose-rate brachytherapy alone for localized prostate cancer in patients at moderate or high risk of biochemical recurrence","volume":"82","author":"Hoskin","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1016\/j.ijrobp.2010.09.006","article-title":"High-dose-rate brachytherapy as a monotherapy for favorable-risk prostate cancer: A phase II trial","volume":"82","author":"Barkati","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_21","first-page":"190","article-title":"High-dose rate iridium192 afterloading therapy in combination with external beam irradiation for localized prostate cancer","volume":"3","author":"Deger","year":"1997","journal-title":"Tech. Urol."},{"key":"ref_22","unstructured":"(1997). Consensus statement: Guidelines for PSA following radiation therapy. American society for therapeutic radiology and oncology consensus panel. Int. J. Radiat. Oncol. Biol. Phys., 37, 1035\u20131041."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.ijrobp.2010.02.013","article-title":"Monotherapeutic high-dose-rate brachytherapy for prostate cancer: Five-year results of an extreme hypofractionation regimen with 54 Gy in nine fractions","volume":"80","author":"Yoshioka","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2869","DOI":"10.1200\/JCO.2000.18.15.2869","article-title":"Matched-pair analysis of conformal high-dose-rate brachytherapy boost versus external-beam radiation therapy alone for locally advanced prostate cancer","volume":"18","author":"Kestin","year":"2000","journal-title":"J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.radonc.2009.08.033","article-title":"Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: A systematic review","volume":"93","author":"Pieters","year":"2009","journal-title":"Radiother. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.eururo.2004.11.014","article-title":"High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer","volume":"47","author":"Deger","year":"2005","journal-title":"Eur. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1016\/j.ijrobp.2004.12.053","article-title":"Lack of benefit from a short course of androgen deprivation for unfavorable prostate cancer patients treated with an accelerated hypofractionated regime","volume":"62","author":"Martinez","year":"2005","journal-title":"Int. J. 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