Outcome comparison of radical prostatectomy versus seed brachytherapy for clinically localized prostate cancer using two biochemical recurrence definitions

BMC Surgery

Research

Jian Lu¹  Fan Zhang¹  Ze-nan Liu¹  Yi Huang¹  Zi-ang Li¹  Ji-de He¹  Lu-lin Ma¹  Xue-hua Zhu² 

[1] Department of Urology, Peking University Third Hospital, Beijing, China;Department of Urology, Peking University Third Hospital, Beijing, China;Department of Urology, Shandong Cancer Hospital and Institude, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China;

关键词: Localized prostate cancer;    Radical prostatectomy;    Seed brachytherapy;    Biochemical recurrence definition;   

DOI  :  10.1186/s12893-023-02121-4

 received in 2023-01-30, accepted in 2023-07-23,  发布年份 2023

来源: Springer

【 摘 要 】

ObjectiveWe compared the outcome of radical prostatectomy (RP) with seed brachytherapy (BT) in clinically localized prostate cancer (LPCa) using two different biochemical recurrence (BCR) definitions.MethodsClinical data of 1117 patients with non-metastatic prostate cancer (PCa) treated with either RP or BT as the basis of the multimodal therapy from a single tertiary hospital between 2007 and 2021 were retrospectively analyzed. 843 LPCa patients (RP = 737, BT = 106) with at least one prostate-specific antigen (PSA) test after treatment were finally included. The BCR survival was evaluated by direct comparison and one-to-one propensity score matching (PSM) analysis using surgical definition (PSA ≥ 0.2ng/ml) for RP and surgical/Phoenix definition (PSA nadir + 2ng/ml ) for BT. The propensity score (PS) was calculated by multivariable logistic regression based on the clinicopathological parameters.ResultsMedian follow-up was 43 months for RP patients and 45 months for BT patients. Kaplan–Meier analysis did not show any statistically significant differences in terms of BCR-free survival (BFS) between the two groups when using Phoenix definition for BT (P > 0.05). Similar results were obtained in all D’Amico risk groups when stratified analyses were conducted. However, RP achieved improved BFS compared to BT in the whole cohort and all risk groups with the surgical definition for BT(P < 0.05). After adjusting PS, 192 patients were divided into RP and BT groups (96 each). RP presented a better BFS than BT when using the surgical definition (P < 0.001), but no significant difference was found when using the Phoenix definition (P = 0.609).ConclusionInconsistent BCR-free survival outcomes were acquired using two different BCR definitions for BT patients. RP provided comparable BFS with BT using the Phoenix definition but better BFS using the surgical definition, regardless of whether the PSM was performed. Our findings indicated that an exact BCR definition was critical for prognostic assessment. The corresponding results will assist physicians in pretreatment consultation and treatment selection.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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