Direct comparison of low-dose-rate brachytherapy versus radical prostatectomy using the surgical definition of biochemical recurrence for patients with intermediate-risk prostate cancer

Hideyasu Tsumura; Nobumichi Tanaka; Tomohiko Oguchi; Takuya Owari; Yasushi Nakai; Isao Asakawa; Kazuyoshi Iijima; Haruaki Kato; Iwao Hashida; Ken-Ichi Tabata; Takefumi Satoh; Hiromichi Ishiyama

doi:10.1186/s13014-022-02046-x

Direct comparison of low-dose-rate brachytherapy versus radical prostatectomy using the surgical definition of biochemical recurrence for patients with intermediate-risk prostate cancer

Radiat Oncol. 2022 Apr 11;17(1):71. doi: 10.1186/s13014-022-02046-x.

Authors

Affiliations

¹ Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan. tsumura@med.kitasato-u.ac.jp.
² Department of Urology, Nara Medical University, Kashihara, Japan.
³ Department of Urology, Nagano Municipal Hospital, Nagano, Japan.
⁴ Department of Radiation Oncology, Nara Medical University, Kashihara, Japan.
⁵ Department of Radiation Therapy, Nagano Municipal Hospital, Nagano, Japan.
⁶ Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
⁷ Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan.

Abstract

Background: We compared the oncological outcomes of patients who received seed brachytherapy (SEED-BT) with those who received radical prostatectomy (RP) for intermediate-risk prostate cancer.

Methods: Candidates were patients treated with either SEED-BT (n = 933) or RP (n = 334). One-to-one propensity score matching was performed to adjust the patients' backgrounds. We compared the biochemical recurrence (BCR)-free rate using the Phoenix definition (prostate-specific antigen [PSA] nadir plus 2 ng/mL) for SEED-BT and the surgical definition (PSA cut-off value of 0.2 ng/mL) for RP. We also directly compared the BCR-free rates using the same PSA cut-off value of 0.2 ng/mL for both SEED-BT and RP.

Results: In the propensity score-matched analysis with 214 pairs, the median follow-up treatment was 96 months (range 1-158 months). Fifty-three patients (24.7%) were treated with combined SEED-BT and external-beam radiotherapy. Forty-three patients (20.0%) received salvage radiotherapy after RP. Comparing the BCR-free rate using the above definitions for SEED-BT and RP showed that SEED-BT yielded a significantly better 8-year BCR-free rate than did RP (87.4% vs. 74.3%, hazard ratio [HR] 0.420, 95% confidence interval [CI] 0.273-0.647). Comparing the 8-year BCR-free rate using the surgical definition for both treatments showed no significant difference between the two treatments (76.7% vs. 74.3%, HR 0.913, 95% CI 0.621-1.341). SEED-BT had a significantly better 8-year salvage hormonal therapy-free rate than did RP (92.0% vs. 85.6%, HR 0.528, 95% CI 0.296-0.942, P = 0.030). The 8-year metastasis-free survival rates (98.5% vs. 99.0%, HR 1.382, 95% CI 0.313-6.083, P = 0.668) and overall survival rates (91.9% vs. 94.6%, HR 1.353, 95% CI 0.690-2.650) did not significantly differ between the treatments.

Conclusions: The BCR-free rates did not significantly differ between patients treated with SEED-BT and those treated with RP for intermediate-risk prostate cancer even when they were directly compared using the surgical definition for BCR. SEED-BT and RP can be adequately compared for oncological outcomes.

Keywords: Brachytherapy; Intermediate risk; Prostate cancer; Radical prostatectomy.

MeSH terms

Brachytherapy* / adverse effects
Humans
Male
Neoplasm Recurrence, Local / surgery
Prostate-Specific Antigen
Prostatectomy / adverse effects
Prostatic Neoplasms* / radiotherapy
Prostatic Neoplasms* / surgery
Retrospective Studies
Salvage Therapy

Substances

Prostate-Specific Antigen