Bibliographic record
Abstract
Introduction and Objective: Brachytherapy has been shown to have equivalent biochemical free and cancer specific survival to other treatment modalities including external beam radiotherapy (EBRT) and surgery for low risk patients.However, intermediate risk patients have historically not been offered brachytherapy as primary treatment.Given the ability to achieve extremely high dose rates that are not locally possible with EBRT, we hypothesize that brachytherapy may be equivalent to EBRT for treatment of intermediate risk prostate cancer.We have adopted its use as monotherapy for this risk group, and evaluated the biochemical control, along with the acute and delayed morbidity post treatment.Methods: A retrospective review of patients treated with brachytherapy between June 2003 and Dec 2008 at the Manitoba Prostate Centre was conducted.Ninety-five patients were treated with brachytherapy alone for intermediate risk disease (T2b or T2c, Gleason score 3+4 = 7 or 4+3 = 7, PSA ≥10 but <20).Only patients with at least 3 post-treatment PSA measurements (n = 57) were assessed for biochemical failure (mean follow-up period 13.75 months, range 8 to 53 months).Biochemical (PSA) failure was defined using the Phoenix, or Nadir+2 definition and secondarily, the traditional American Society for Therapeutic Radiology and Oncology (ASTRO) definition of 3 consecutive rises over nadir.We also evaluated acute and late morbidities including urinary and bowel symptoms, and erectile dysfunction in all 95 patients.Results: Of the 95 patients evaluated, no adjuvant treatment was given for biochemical control.In the 57 patients assessed for biochemical failure, PSA nadir ranged between 0.01 to 2.86; mean time to nadir = 22 months (range 2-57 months).Biochemical failure occurred in 1 patient (Phoenix) and in 2 patients (ASTRO).Within the entire study population (n = 95), 18 patients (19% ± 8%, 0.95 CI) had urinary retention > 2 weeks requiring catheterization; 4 patients (4.2% ± 4%, 0.95 CI) developed erectile dysfunction post treatment and 2 patients reported some degree of urinary incontinence.Conclusions: Our results suggest that biochemical control can be achieved with brachytherapy alone for intermediate risk localized prostate cancer, with an acceptable rate of treatment related morbidity.Brachytherapy might be an alternative standard of care treatment for localized, intermediate risk prostate cancer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.606 | 0.384 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".