Mortality and biochemical recurrence after surgery, brachytherapy, or external radiotherapy for localized prostate cancer: a 10-year follow-up cohort study
José Francisco Suárez, Víctor Zamora, Olatz Garín, Cristina Gutiérrez, Àngels Pont, Yolanda Pardo, Alai Goñi, Alfonso Mariño, A. Hervás, Ismael Herruzo, Patricia Cabrera, Gemma Sancho, Javier Ponce de León, Víctor Macías, Ferrán Guedea, Francesc Vigués, Manuel Castells, Montse Ferrer, Montse Ferrer, Olatz Garín, Àngels Pont, Yolanda Pardo, Jordi Alonso, Víctor Zamora, Ferrán Guedea, Montse Ventura, Cristina Gutiérrez, Ferrán Ferrer, A. Boladeras, José Francisco Suárez, Manel Castells, Xavier Bonet, Mónica Ávila, Sergi Pastor, Carmen Utrera Bonet, Gemma Sancho, Javier Ponce de León, Joan Palou, Belén de Paula, Alai Goñi, Pablo Fernández, Ismael Herruzo, A. Hervás, Alfredo Ramos, Víctor Macías, Josep María Macias i Solé, Marta Bonet, Alfonso Mariño, Patricia Cabrera, María José Ortiz
Abstract
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 125 I 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.