The Radical Prostatectomy Versus Brachytherapy for the Management of Low- and Intermediate-Risk Prostate Cancer: A...

This study aims to compare the oncological outcomes of radical prostatectomy (RP) and brachytherapy (BT) in patients with low- and intermediate-risk prostate cancer, and determine whether one treatment demonstrates superiority over the other.

A systematic literature search was conducted using databases, including PubMed, ScienceDirect, Google Scholar, EBSCO, and the Cochrane Library, to identify relevant clinical studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted, with HRs >1 indicating RP superiority and HRs <1 indicating BT superiority. Outcomes assessed included biochemical relapse-free survival (BCRFS), clinical relapse-free survival (CRFS), overall survival (OS), and cancer-specific survival (CSS). Statistical analyses, including heterogeneity, publication bias, and risk of bias, were performed using R Studio 4.3.3 and Review Manager (RevMan) 5.4.

A total of seven studies involving 5663 patients were included in the analysis, with 2389 patients receiving brachytherapy (BT) and 3274 undergoing radical prostatectomy (RP). The pooled results demonstrated that BT was associated with significantly better biochemical relapse-free survival (BCRFS) compared to RP, with an HR of 0.84 (95% CI: 0.78-0.89; p<0.01). Although clinical relapse-free survival (CRFS) also favored BT, the result was not statistically significant (HR 0.90; 95% CI: 0.77-1.05; p=0.17). For overall survival (OS) and cancer-specific survival (CSS), the differences between the two treatment modalities were not statistically significant, with HRs of 1.08 (95% CI: 0.87-1.34; p=0.50) and 1.05 (95% CI: 0.82-1.36; p=0.70), respectively. Subgroup analyses based on risk stratification and follow-up duration revealed variability in treatment outcomes, particularly favoring BT in certain intermediate-risk groups.

This meta-analysis suggests that brachytherapy may offer superior outcomes in biochemical and clinical relapse-free survival compared to radical prostatectomy in patients with low- and intermediate-risk prostate cancer. However, no significant differences were observed in overall survival or cancer-specific survival, highlighting the need for individualized treatment decision-making based on patient risk profiles and preferences.