Comparative 5-year outcomes of brachytherapy and surgery for prostate cancer
Received 13 October 2009; received in revised form 15 December 2009; accepted 31 December 2009. published online 07 June 2010. Corrected Proof
Abstract
Purpose
To compare the predicted outcome by radical retropubic prostatectomy (RRP) of patients actually treated with prostate brachytherapy (PB) for low- and intermediate-risk prostate cancer, using a surgical nomogram.
Methods and Materials
Data of consecutive patients treated with PB from the start of our program in 1998 to February 1, 2005 were extracted from a prospectively maintained database that records patient, tumor, and outcomes information. Prognostic features of each patient and brachytherapist experience were entered into a nomogram of surgical outcomes that incorporates surgeon experience. The definition of failure was a rising prostate specific antigen (PSA) >0.4ng/mL or secondary intervention. Comparisons of actual PB outcome vs. predicted surgical outcome were compared using the log-rank test.
Results
One thousand two hundred fifty-four patients were treated in this era, and all are included for analysis. The median followup is 56 months. Forty-six percent have stage T1, and 54% have stage T2 cancer. Twenty-five percent have Gleason 7 disease, and the median PSA is 6.3ng/mL (range, 0.3–19.6ng/mL). Fifty-eight percent have low-risk disease, and 41% have intermediate-risk disease. Androgen deprivation therapy was used for 6 months in 92% of intermediate-risk and 46% of low-risk cases. The median PSA at last followup is 0.06ng/mL. Five-year biochemical no evidence of disease rate with PB is 90.6%, and that predicted with RRP is 86.8%, p=0.003.
Conclusions
Excellent PB outcomes are observed that exceed that predicted from the use of RRP.
1BCCA PB Program, Vancouver Clinic, British Columbia Cancer Agency, Canada
2Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
Corresponding author. Radiation Program, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V6R2T9, Canada. Tel.: +1-604-877-6000 x2665; fax: +1-604-877-0505.
ABSTRACT
ng/mL or secondary intervention. Comparisons of actual PB outcome vs. predicted surgical outcome were compared using the log-rank test.