Comparison of the oncological and functional outcomes of brachytherapy and radical prostatectomy for localized prostate cancer
Abstract Objective:To compare the oncological and functional outcomes of brachytherapy(BT) and radical prostatectomy(RP) in patients with localized prostate cancer(PCa).Methods:We retrospectively analyzed data from 415 patients with localized PCa who were treated with RP (n= 280) or BT (n=135) at Northern Jiangsu People's Hospital between November 2012 and April 2019. Biochemical relapse-free survival(bRFS) and cancer-specific survival (CSS) were compared. Multivariate Cox regression analysis was used to evaluate bRFS. Health-related quality of life(HRQoL) was measured using the Expanded Prostate Cancer Index Composite(EPIC) questionnaire.Results:The BT group was older, had a higher initial PSA, and had a higher proportion of high-risk patients. The median follow-up time was 38.6 months. The 3-year bRFS was 77.3% in the RP group versus 84.0% in the BT group(P=0.246). For the RP group, the 3-year bRFS for patients presenting with low-, intermediate-, and high-risk disease was 90.3%, 79.6% and 71.3%, respectively, compared with 90.9%, 93.8% and 80.7% in the BT group(P=0.948,0.213,0.263, respectively). The 3-year CSS was 96.1% in the RP group versus 94.5% in the BT group(P=0.948). For the RP group, the 3-year CSS for patients presenting with low-, intermediate-, and high-risk disease was 100%, 100% and 92.8%, respectively, compared with 100%, 100% and 92.4%, for the BT group(P=0.620). Based on multivariate Cox regression analysis, clinical T stage ≥ T2b was the main independent prognostic factor for bRFS. Regarding the quality of life, compared with the baseline, both treatments produced a significant decrease in different aspects of HRQoL at 3, 6 and 12 months after treatment. Patients in the BT group had lower HRQoL with regard to urinary irritation/obstruction and bowel function or bother, while patients in the RP group had lower HRQoL concerning urinary incontinence and sexual function or bother. There was no significant difference in HRQOL aspects between the two groups after follow-up for 2 years compared with the baseline.Conclusion:BT provides equivalent oncological control outcomes for patients with localized PCa compared with RP. Clinical T stage ≥ T2b was the independent prognostic factor for bRFS. BT had better HRQoL compared with RP, except for urinary irritation/obstruction and bowel function or bother, but returned to baseline after 2 years.