Objective: To compare long-term biochemical control of high-risk prostate cancer in those men receiving high-dose rate brachytherapy (HDRB) and radical prostatectomy (RP).
Patients and methods: The 10-year biochemical freedom from relapse (BFR) was calculated for 243 patients who underwent either RP or combined therapy with HDRB + external beam radiotherapy + androgen deprivation between 1998 and 2000. Inclusion criteria: clinical stage ≥ T2b, or Gleason sum ≥ 8, or PSA level of > 20 ng/mL. Groups were appraised using the Kattan nomogram for surgery to calculate progression-free probability (PFP).
Results: For the RP group (153 patients) the median PSA level was 8.1 ng/mL and the median age was 62.2 years. The median 5- and 10-year predicted PFP for RP was 64% and 56 %, respectively. The 5- and 10-year BFR was 65.5% and 55.4%. There was no significant difference between the predicted and the actual PFP for the RP group (P= 0.525). For HDRB group (90 patients). The median PSA level was 14.2 ng/mL and the median age was 67.6 years. The median 5- and 10-year predicted PFP for HDRB was 46% and 35%, respectively. The 5- and 10-year BFR was 79.6% and 53.6%. There was a significant improvement between the actual and the predicted PFP for the HDRB group (P= 0.002).
Conclusions: Amongst a high-risk cohort, patients undergoing RP performed as predicted by the pre-treatment surgical nomogram, whereas the patients undergoing HDRB performed significantly better than was predicted by the surgical nomogram at 10 years.
Written by:
Savdie R, Symons J, Spernat D, Yuen C, Pe Benito RA, Haynes AM, Matthews J, Rasiah KK, Jagavkar RS, Yu C, Fogarty G, Kattan MW, Brenner P, Sutherland RL, Stricker PD. Are you the author?
Prostate Cancer Group, Cancer Research Programme, Garvan Institute of Medical Research Department of Urology, St Vincent's Hospital St.Vincent's Prostate Cancer Centre Department of Radiation Oncology, St.Vincent's Hospital, Darlinghurst, NSW, Australia; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
Reference: BJU Int. 2012 Dec;110 Suppl 4:71-6.
doi: 10.1111/j.1464-410X.2012.11480.x
PubMed Abstract
PMID: 23194129
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