Survival With Brachytherapy-Based Radiotherapy or Radical Prostatectomy in High-Risk Localized Prostate Cancer

Key Points

  • No significant difference in overall survival was found for radical prostatectomy vs EBRT plus brachytherapy with or without androgen deprivation.
  • EBRT plus androgen deprivation was associated with poorer overall survival.

In a study of National Cancer Database data reported in the Journal of Clinical Oncology, Ennis et al found no significant survival differences between patients receiving brachytherapy-based radiotherapy vs radical prostatectomy in men with high-risk localized prostate cancer.

Study Details

The study involved data from 42,765 patients in the National Cancer Database diagnosed between 2004 and 2013 who were treated with radical prostatectomy (RP, n = 24,688); external beam radiotherapy (EBRT) combined with androgen deprivation (AD, n = 15,435); or EBRT plus brachytherapy with or without AD (n = 2,642). Inverse probability of treatment weighting was used to adjust for covariable imbalance among treatment groups. A weighted time-dependent Cox proportional hazards model was used to estimate effects of treatment group on survival, while accounting for differential treatment initiation times.

Overall Survival

In weighted analysis adjusting for age, prostate-specific antigen score, clinical T stage, Charlson-Deyo score, biopsy Gleason score, and year of diagnosis, no significant difference in overall survival was observed for RP vs EBRT plus brachytherapy with or without AD (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 0.88–1.55). EBRT plus AD was associated with greater mortality risk vs RP (HR = 1.53, 95% CI = 1.22–1.92). Adjustment of models for predicted pathologic nodal status did not result in statistically different results. Sensitivity analysis indicated that the HR for mortality in the EBRT plus AD subgroup receiving total radiation dose ≥ 7,920 cGy was 1.33 (95% CI = 1.05–1.68), lower than that in the subgroup receiving < 7,920 cGY (HR = 1.68, 95% CI = 1.37–2.06).

The investigators concluded, “After comprehensively adjusting for imbalances in prostate cancer prognostic factors, other medical conditions, and socioeconomic factors, this analysis showed no statistical difference in survival between patients treated with RP vs EBRT plus brachytherapy with or without AD. EBRT plus AD was associated with lower survival.”

Ronald D. Ennis, MD, of the Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.