Assuming a prostate alpha/beta ratio of 1.5, these programs CH5424802 supplier provided BED in the range

of 237–354 Gy, considerably higher than the BED of 178 Gy achieved with EBRT to a total dose of 81 Gy in 1.8 Gy/fraction (43). As a result of these favorable initial clinical experience with HDR monotherapy, several radiation oncologists around the world started HDR monotherapy programs of their own (Table 1, Table 2 and Table 3). Most of the centers providing HDR monotherapy follow, or started by following, programs similar to the Osaka, CET, or WBH. Grills et al. (44) in the United States were the first to report the toxicity profile of HDR monotherapy. They assessed comparably match HDR and permanent seed implant, mostly low risk group, followed buy DAPT a median of 35 months (65 patients HDR 9.5 Gy × 4 vs. 84 patients Palladium103 120 Gy). ASTRO definition PSA control disease–free survival was equally high for both treatments

(97% and 98%). The majority of toxicities were Grade 1. Acute side effects were significantly lower with HDR (dysuria 36% vs. 67%, frequency/urgency 54% vs. 92%, and rectal pain 6% vs. 20%). Chronic frequency/urgency was also less with HDR 32% vs. 56%. Urethral stricture rates were not statistically different (8% vs. 3% p = 0.17). Potency preservation was better for HDR 83% vs. 55%. WBH and CET did a comprehensive toxicity comparison between 248 HDR monotherapy patients and 206 103Pd permanent seeds patients (45). A short course (<6 months) Ribonucleotide reductase of neoadjuvant ADT was used in 30% of patients. The 5-year actuarial biochemical control for monotherapy was 88% for HDR and 89% for seeds. There was no difference in cancer mortality

or overall survival. HDR brachytherapy was associated with statistically significant reductions in acute rates of dysuria (seeds 60% vs. HDR 39%) and urgency/frequency (seeds 91% vs. HDR 58%). HDR was also associated with lower rates of rectal pain (seeds 17% vs. HDR 7%). Chronic toxicity: HDR brachytherapy was associated with significantly less Grade 1–2 chronic dysuria (seeds 22% vs. HDR 15%) and urinary frequency and urgency (seeds 54% vs. HDR 43%). The occurrence of hematuria was slightly greater for HDR than seeds (11% vs. 7%). The rate of urethral stricture was equal (seeds 2.5% seeds vs. HDR 3%) with the median time to diagnosis of 17 months. Chronic Grade 3 GU toxicity was low in both groups. Approximately 75% of the HDR toxicities were self-limited and required little or no intervention (Grade 1), 23% responded to therapy (Grade 2), and about 2% had more prolong or more severe (Grade 3) symptoms (mostly urinary frequency/urgency). No HDR patient had Grade 4 toxicity. Erectile dysfunction data were available for study in 58% of the cases.