Taussky Daniel, Ouellet Véronique, Delouya Guila, Saad Fred
Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montreal, QC, Canada.
Research Centre, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
Can Urol Assoc J. 2016 Aug;10(7-8):246-250. doi: 10.5489/cuaj.3537.
We sought to compare the outcomes between radical prostatectomy (RP) and permanent seed prostate brachytherapy (PB) in patients with low- and low-intermediate-risk prostate cancer from a single tertiary care centre.
Patients were selected from our institute's internal database based on preoperative selection criteria from the National Comprehensive Cancer Network (NCCN) guidelines (2015) for low- and intermediate-risk patients. No patient had received any neo-adjuvant androgen-deprivation therapy. The endpoint was biochemical recurrence (BCR) or any salvage treatment for both RP and PB at 48 ± 4 months after treatment. The biochemical relapse threshold was set at prostate-specific antigen (PSA) ≥0.5 ng/mL for PB and two PSA values of ≥0.2 ng/mL for RP. Patients from both treatment groups were compared using non-parametric tests. A binary logistic regression analysis was performed to determine an association of treatment and pretreatment factors with a BCR at 48 months.
A total of 575 patients were included in this study; 254 were treated with RP and 321 with PB. BCR was not different between both groups (p=0.84, Chi-square test), and occurred in 21.2% of patients treated with RP and in 20.6% with PB. Based on univariate and multivariate logistic regression analyses, younger age, higher percentage of positive biopsies, and initial PSA were predictive of BCR. Treatment modality was not predictive in either univariate (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.64-1.44; p=0.84) or multivariate (OR 1.43, 95% CI 0.89-2.30; p=0.14) analyses.
Using closely related cutoff values for BCR, both RP and PB did not have significantly different outcomes at four years post-treatment. A longer followup may be necessary to detect a difference between treatments.
我们试图比较来自单一三级医疗中心的低风险和低中风险前列腺癌患者接受根治性前列腺切除术（RP）和永久性粒子植入前列腺近距离放射治疗（PB）后的结果。
根据美国国立综合癌症网络（NCCN）指南（2015年版）中低风险和中风险患者的术前选择标准，从我们研究所的内部数据库中选取患者。所有患者均未接受过任何新辅助雄激素剥夺治疗。终点指标为治疗后48±4个月时的生化复发（BCR）或RP和PB的任何挽救性治疗。PB的生化复发阈值设定为前列腺特异性抗原（PSA）≥0.5 ng/mL，RP的生化复发阈值设定为两个PSA值≥0.2 ng/mL。使用非参数检验对两个治疗组的患者进行比较。进行二元逻辑回归分析以确定治疗和治疗前因素与48个月时BCR的关联。
本研究共纳入575例患者；254例接受RP治疗，321例接受PB治疗。两组之间的BCR无差异（p=0.84，卡方检验），接受RP治疗的患者中21.2%发生BCR，接受PB治疗的患者中20.6%发生BCR。基于单因素和多因素逻辑回归分析，年龄较小、活检阳性百分比更高和初始PSA可预测BCR。治疗方式在单因素分析（比值比[OR]0.96，95%置信区间[CI]0.64-1.44；p=0.84）或多因素分析（OR 1.43，95%CI 0.89-2.30；p=0.14）中均无预测性。
使用密切相关的BCR临界值，RP和PB在治疗后四年的结果均无显著差异。可能需要更长时间的随访来发现治疗之间的差异。
