Comparative 5-year outcomes of brachytherapy and surgery for prostate cancer

To compare the predicted outcome by radical retropubic prostatectomy (RRP) of patients actually treated with prostate brachytherapy (PB) for low- and intermediate-risk prostate cancer, using a surgical nomogram.

Data of consecutive patients treated with PB from the start of our program in 1998 to February 1, 2005 were extracted from a prospectively maintained database that records patient, tumor, and outcomes information. Prognostic features of each patient and brachytherapist experience were entered into a nomogram of surgical outcomes that incorporates surgeon experience. The definition of failure was a rising prostate specific antigen (PSA) >0.4 ng/mL or secondary intervention. Comparisons of actual PB outcome vs. predicted surgical outcome were compared using the log-rank test.

One thousand two hundred fifty-four patients were treated in this era, and all are included for analysis. The median followup is 56 months. Forty-six percent have stage T1, and 54% have stage T2 cancer. Twenty-five percent have Gleason 7 disease, and the median PSA is 6.3 ng/mL (range, 0.3-19.6 ng/mL). Fifty-eight percent have low-risk disease, and 41% have intermediate-risk disease. Androgen deprivation therapy was used for 6 months in 92% of intermediate-risk and 46% of low-risk cases. The median PSA at last followup is 0.06 ng/mL. Five-year biochemical no evidence of disease rate with PB is 90.6%, and that predicted with RRP is 86.8%, p=0.003.

Excellent PB outcomes are observed that exceed that predicted from the use of RRP.