Combined-modality 125J-seed-brachytherapy, external beam radiation and androgen deprivation therapy of unfavorable-risk prostate cancer: report of outcomes and side-effects

  • A. BoehleEmail author
  • K. Katic
  • I. R. König
  • I. Robrahn-Nitschke
  • P. Renner
  • B. Brandenburg
Original Article



To analyze outcomes and complication rates in an unselected cohort of men with unfavorable (NCCN intermediate and high-risk) PCa receiving combined-modality radiation treatment (CRT).


Patients received androgen deprivation therapy for 1 year and combined-modality radiation treatment (CRT) consisting of external-beam radiotherapy (EBRT, 59.4 Gy, 33 fractions) and 125J seed-brachytherapy (S-BT, 100 Gy). Subgroups, including WHO group 3–5, and initial PSA (iPSA) < 20 and > 20 ng/ml were identified. Biochemical recurrence-free (BRFS), metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) were calculated at 5 and 10 years using the Kaplan–Meier method. Subgroups were compared using log-rank test and Cox proportional hazards regression. Urogenital and gastrointestinal side-effects were reported according to the CTCAE classification.


After a median of 6.9 years (range 2–13) calculated 5- and 10-year rates for the whole cohort of 425 men were 92.8% and 82.5% for BRFS, 95.1%, and 88.8% for MFS, 98.2%, and 95.1 for CSS, and 95.4%, and 80.1% for OS, respectively. Univariate (UVA) and multivariate analysis (MV) identified a group with unfavorable outcome with iPSA > 20 ng/ml, comprising 24% of all patients, in which 55% of recurrences, 54% of metastases and 71% of cancer-specific deaths occurred. Side-effects were limited, with < 5% of patients complaining of genitourinary and 0.5% of gastrointestinal AEs after 5 years.


CRT is an excellent treatment option for men with unfavorable PCa. In a subgroup of patients with iPSA > 20 ng/ml further, possibly systemic, treatment options should be identified.


High-risk prostate cancer Radiotherapy Seed-brachytherapy LDR-brachytherapy Outcome research Side-effects 



The excellent technical support of Ralph Luers, Bjarne Riis and Patrick Voss is gratefully acknowledged.

Author contributions

AB: protocol development, data analysis, manuscript writing and editing. KK: data collection, data analysis, manuscript editing. IRK: data analysis, manuscript editing. IR-N: manuscript editing. PR: manuscript editing. BB: protocol development, manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent was not required.

Supplementary material

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Supplementary material 1 (docx 17 kb)
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Supplementary material 2 (docx 28 kb)
345_2019_2649_MOESM3_ESM.docx (19 kb)
Supplementary material 3 (docx 19 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity of LuebeckLuebeckGermany
  2. 2.HELIOS Agnes-Karll Hospital Bad SchwartauBad SchwartauGermany
  3. 3.Institute for Medical Biometry and StatisticsUniversity of LuebeckLuebeckGermany
  4. 4.CURAVID Radiology and RadiotherapyLuebeckGermany
  5. 5.Department of UrologySANA HospitalLuebeckGermany
  6. 6.Urologisches GesundheitszentrumBad SchwartauGermany

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