Mortality and biochemical recurrence after surgery, brachytherapy, or external radiotherapy for localized prostate cancer: a 10-year follow-up cohort study

Abstract

To compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with 125I brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan–Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making.Study identifier at ClinicalTrials.gov: NCT01492751.

Comparison of the Oncological and Functional Outcomes of Brachytherapy and Radical Prostatectomy for Localized Prostate Cancer

“…Guo et al deemed that BT offers oncological outcomes similar to RP in elderly patients with localized PCa. In a recent study, Suárez et al reported a comparative study of mortality and biochemical recurrence after RP, BT, or external radiotherapy for localized PCa patients at 10 years of follow-up, and BT presented high overall survival similarly to RP, but higher risk of biochemical progression [ 19 ]. These results were similar to our study.…”

Early Treatment Intensification in Metastatic Hormone-Sensitive Prostate Cancer

“…1 Even among patients treated with definitive local therapy (prostatectomy or radiotherapy [RT]), approximately 30% will recur within 10 years, and a substantial fraction will develop metastases. 2…”

“…1 Even among patients treated with definitive local therapy (prostatectomy or radiotherapy [RT]), approximately 30% will recur within 10 years, and a substantial fraction will develop metastases. 2 Prostate cancer is highly dependent on androgen signaling for growth and survival. Withdrawal of testosterone via ACCOMPANYING CONTENT Article, p. 3595…”

Intermediate‐term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score‐matched analysis

“…2 The BCR rate of brachytherapy (BT) ranges from 16% to 20%. 3,4 In addition, cryotherapy (CRYO) has emerged as a primary treatment option, especially in selected low-and intermediate-risk patients owing to its competitive oncological and excellent urinary continence outcomes. [5][6][7] The BCR rate after primary CRYO ranges from 20% to 40% based on Phoenix criteria.…”