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282 consecutive patients with high risk prostate cancer were treated from 1992 through 1996 by one author (M.D.). Each patient had at least one higher risk feature of Gleason Score 7-10 (172 patients), PSA >10 (166 patients). 113 patients met both high risk criteria. 67 patients also had elevated prostatic acid phosphatase (PAP). Clinical stage (109 patients with T2C and 107 patients with T3 disease)was not included in this data analysis to reduce subjectivity. Patients received a median 41 Gy 3D-CRT to a limited pelvic field (range 39-54 Gy), followed by a Pd-103 boost (minimum peripheral dose 8000-9000 cGy pre-NIST-99, median seed activity 1.4 mCi). Generous brachytherapy margins were utilized; the clinical target volume extended 0.5-1.0 cm antero-laterally to the TRUS prostate margin. 103 patients received neo-adjuvant or adjunctive hormones, median duration 4 months (maximum 6 months). Biochemical success was
defined as a serum PSA 0.2 ng/ml at last follow-up, while patients whose PSAs nadired at a value of >0.2 ng/ml were scored as failures. The follow-up period for non-failing patients ranged from 1-13 years (median: 9 years). Freedom from failure curves were calculated by the method of Kaplan-Meier. Differences between groups were determined by log-rank or students' t-test. Biochemical data and original biopsy slides were independently re-reviewed at the University of Washington
(K.W. and L. T. respectively).
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