Mortality and biochemical recurrence after surgery, brachytherapy, or external radiotherapy for localized prostate cancer: a 10-year follow-up cohort study
Por:
Suarez, JF, Zamora, V, Garin, O, Gutierrez, C, Pont, A, Pardo, Y, Goni, A, Marino, A, Hervas, A, Herruzo, I, Cabrera, P, Sancho, G, de Leon, JP, Macias, V, Guedea, F, Vigues, F, Castells, M, Ferrer, M
Publicada:
22 jul 2022
Resumen:
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 I-125 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.
Filiaciones:
Suarez, JF:
Hosp Univ Bellvitge, Urol Dept, Barcelona, Spain
Zamora, V:
IMIM Hosp del Mar, Hlth Serv Res Grp, Med Res Inst, Doctor Aiguader 88, Barcelona 08003, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Garin, O:
IMIM Hosp del Mar, Hlth Serv Res Grp, Med Res Inst, Doctor Aiguader 88, Barcelona 08003, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Univ Pompeu Fabra UPF, Barcelona, Spain
Gutierrez, C:
Inst Catala Oncol, Radiat Oncol Dept, Barcelona, Spain
Pont, A:
IMIM Hosp del Mar, Hlth Serv Res Grp, Med Res Inst, Doctor Aiguader 88, Barcelona 08003, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Pardo, Y:
IMIM Hosp del Mar, Hlth Serv Res Grp, Med Res Inst, Doctor Aiguader 88, Barcelona 08003, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Goni, A:
Fdn Onkol UGC Oncol Gipiizcoa, Radiat Oncol Serv, San Sebastian, Spain
Marino, A:
Ctr Oncol Galicia, Radiat Oncol Dept, La Coruna, Spain
Hervas, A:
Hosp Univ Ramon y Cajal, Radiat Oncol Dept, Madrid, Spain
Herruzo, I:
Hosp Reg Univ Malaga, Radiat Oncol Dept, Malaga, Spain
Cabrera, P:
Hosp Univ Virgen del Rocio, Radiat Oncol Dept, Seville, Spain
Sancho, G:
Hosp Santa Creu & Sant Pau, Radiat Oncol Dept, Barcelona, Spain
de Leon, JP:
Fundacio Puigvert, Urol Dept, Barcelona, Spain
Macias, V:
Hosp Univ & Politecn La Fe, Radiat Oncol Dept, Valencia, Spain
Guedea, F:
Inst Catala Oncol, Radiat Oncol Dept, Barcelona, Spain
Vigues, F:
Hosp Univ Bellvitge, Urol Dept, Barcelona, Spain
Castells, M:
Hosp Univ Bellvitge, Urol Dept, Barcelona, Spain
Ferrer, M:
IMIM Hosp del Mar, Hlth Serv Res Grp, Med Res Inst, Doctor Aiguader 88, Barcelona 08003, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Univ Pompeu Fabra UPF, Barcelona, Spain
gold, Green Published, Gold, Green
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