Clinical Original Article
125I low-dose-rate prostate brachytherapy and radical prostatectomy in patients with prostate cancer
Zhou Zhien, Yan Weigang, Zhou Yi, Wu Xingcheng, Zheng Zhibo, Zhang Fuquan, Ji Zhigang, Li Hanzhong
Published 2020-05-15
Cite as Chin J Urol, 2020, 41(5): 362-367. DOI: 10.3760/cma.j.cn112330-20200117-00035
Abstract
ObjectiveTo compare the outcomes of low-dose-rate prostate brachytherapy (BT) and radical prostatectomy (RP) in patients with T1c-T3a prostate cancer.
MethodsA group of 745 patients with T1c-T3a prostate cancer between January 2010 and August 2017 at Peking Union Medical College Hospital were identified. The records of these patients, who were followed up for a minimum of 2 years, were reviewed. 384 cases received BT. Their characters included age(72.1±6.6), tPSA (12.4±6.1) ng/ml, prostate volume (33.6±13.8) ml, Gleason grade group (2.0±1.2). In this group, T1c-T2a stage was diagnosed in 189 cases, T2b-T2c stage in 182 cases and T3a stage in 13 cases.361 cases received RP. Their characters included age(65.7±6.2), tPSA(12.6±6.4) ng/ml, prostate volume (37.2±17.8) ml, Gleason grade group (1.9±1.2). In this group, T1c-T2a stage was diagnosed in 177 cases, T2b-T2c stage in 170 cases and T3a stage in 14 cases.The log-rank test compared survival rates between the two modalities, and Cox regression identified factors associated with bRFS.
ResultsMedian follow-up was 60 months. Kaplan-Meier analysis did not show any statistically significant differences in terms of cRFS(P=0.321), cancer specific survival (CSS, P=0.643) and overall survival (OS, P=0.565) rate between the two groups. BT was associated with improved bRFS compared to RP(P=0.018). Risk of biochemical recurrence was significantly lower with BT compared with RP in the patients with a biopsy Gleason grade group 2 and 3 (P=0.008), or prostate volume ≤35 ml (P=0.027), or tPSA ≤10 ng/ml (P=0.013), or the clinical T stages of T2b and T2C(P=0.031), or in the intermediate-risk group according to NCCN risk classification (P=0.003). On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T2b was associated with significantly shorter bRFS.
ConclusionsBT produced equivalent cRFS, CSS and OS compared to RP, while it was associated with improved bRFS. BT On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T2b was associated with significantly lower bRFS.
Key words:
Prostate neoplasms; Prostate cancer; Brachytherapy; Radical prostatectomy
Contributor Information
Zhou Zhien
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Yan Weigang
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Zhou Yi
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Wu Xingcheng
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Zheng Zhibo
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Zhang Fuquan
Department of Radiotherapy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Ji Zhigang
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Li Hanzhong
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
