Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 2011 Jul;186(1):91-6. doi: 10.1016/j.juro.2011.03.003. Epub 2011 May 14.
Radical prostatectomy and brachytherapy are widely used treatments for favorable risk prostate cancer. We estimated the risk of prostate cancer specific mortality following radical prostatectomy or brachytherapy in men with low or intermediate risk prostate cancer using prospectively collected data.
The study cohort comprised 5,760 men with low risk prostate cancer (prostate specific antigen 10 ng/ml or less, clinical category T1c or 2a and Gleason score 6 or less), and 3,079 with intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, clinical category T2b or T2c, or Gleason score 7). Competing risks multivariable regression was performed to assess the risk of prostate cancer specific mortality after radical prostatectomy or brachytherapy, adjusting for age, year of treatment, cardiovascular comorbidity and known prostate cancer prognostic factors.
After a median followup of 4.2 years (IQR 2.0-7.4) for low risk and 4.8 years (IQR 2.2-8.1) for intermediate risk men, there was no significant difference in the risk of prostate cancer specific mortality among low risk (adjusted hazard ratio 1.62, 95% CI 0.59-4.45, p = 0.35) or intermediate risk men (AHR 2.30, 95% CI 0.95-5.58, p = 0.07) treated with brachytherapy compared with radical prostatectomy. The only factor associated with an increased risk of prostate cancer specific mortality (AHR 1.05, 95% CI 1.01-1.10, p = 0.03) was increasing age at treatment in intermediate risk men.
The risk of prostate cancer specific mortality in men with low or intermediate risk prostate cancer was not significantly different following radical prostatectomy vs brachytherapy.
根治性前列腺切除术和近距离放射治疗是治疗低危和中危前列腺癌的常用方法。我们使用前瞻性收集的数据，估计低危和中危前列腺癌患者接受根治性前列腺切除术或近距离放射治疗后前列腺癌特异性死亡率的风险。
研究队列包括 5760 名低危前列腺癌患者（前列腺特异性抗原 10ng/ml 或更低，临床分期 T1c 或 2a 级和 Gleason 评分 6 分或更低）和 3079 名中危前列腺癌患者（前列腺特异性抗原 10 至 20ng/ml，临床分期 T2b 或 T2c 级，或 Gleason 评分 7 分）。采用竞争风险多变量回归分析评估根治性前列腺切除术或近距离放射治疗后前列腺癌特异性死亡率的风险，调整年龄、治疗年份、心血管合并症和已知的前列腺癌预后因素。
在低危组中位随访 4.2 年（IQR 2.0-7.4）和中危组中位随访 4.8 年（IQR 2.2-8.1）后，低危组（调整后的危险比 1.62，95%CI 0.59-4.45，p=0.35）或中危组（调整后的危险比 2.30，95%CI 0.95-5.58，p=0.07）接受近距离放射治疗与根治性前列腺切除术的前列腺癌特异性死亡率无显著差异。只有中危组患者年龄（调整后的危险比 1.05，95%CI 1.01-1.10，p=0.03）是前列腺癌特异性死亡率增加的唯一相关因素。
低危和中危前列腺癌患者接受根治性前列腺切除术与近距离放射治疗后，前列腺癌特异性死亡率无显著差异。
