ONCOmmunity

Ten-Year Treatment Outcomes of Radical Prostatectomy vs External Beam Radiation Therapy vs Brachytherapy for 1,503 Patients with Intermediate Risk Prostate Cancer.

By: Barry W Goy, Raoul Burchette, Margaret S Soper, Tangel Chang, Harry A Cosmatos

ᵃDepartment of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, U.S.A.; ᵇDepartment of Research and Evaluation, Kaiser Permanente, Pasadena, CA, U.S.A.; ᶜDepartment of Radiation Oncology, University Hospital Cleveland Medical Center, Cleveland, OH, U.S.A.. Electronic address: barry.w.goy@kp.org.
2019-06-22; doi: 10.1016/j.urology.2019.09.040

Abstract

Purpose

To compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate risk prostate cancer (IRPC).

Methods

A retrospective analysis using propensity score matching was performed on 1,503 IRPC patients who underwent treatment from 2004 to 2007. 819 underwent RP, 574 underwent EBRT to a median dose of 75.3 Gray, and 110 underwent BT using Iodine-125. Biochemical failure was defined by the American Urological Association (AUA) definition of failure for RP, and the Phoenix definition for EBRT and BT.

Results

Median follow-up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy (NADT) was given in 0.6% of RP, 58.9% of EBRT, and 12.7% of BT patients, p<0.0001. Only 14% of BT received supplemental external radiation. The adjusted 10-year freedom from biochemical failure (FFBF) was 80.2% for BT vs 57.1% for RP vs 57.0% for EBRT, p=0.0003. Subset analysis of unfavorable IRPC also showed improved FFBF with BT, p<0.0001. There were no significant differences in distant metastases-free survival (DMFS) or prostate cancer-specific survival (PCSS) after adjusting for age and Charlson comorbidity index.

Conclusions

BT using Iodine-125, used alone or in combination with supplemental external radiation, is a reasonable treatment option for IRPC patients, yielding equivalent rates of DMFS and PCSS.