Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader, 88, Barcelona, Spain, 08003.
Sci Rep. 2022 Jul 22;12(1):12589. doi: 10.1038/s41598-022-16395-w.
To compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with I brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan-Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making.Study identifier at ClinicalTrials.gov: NCT01492751.
比较根治性前列腺切除术、近距离放射治疗和外部放射治疗在 10 年随访时的总体生存率、前列腺癌特异性死亡率和生化复发率。这项研究纳入了来自西班牙 10 家医院的局部前列腺癌（T1/T2 和低/中危）男性患者队列，随访 10 年。治疗选择由患者和医生共同决定。在 704 名参与者中，192 人接受了开放式经直肠前列腺切除术，317 人接受了单纯 I 近距离放射治疗，195 人接受了 3D 外部束放射治疗。我们评估了总体生存率、前列腺癌特异性死亡率和生化复发率。绘制了 Kaplan-Meier 估计值，并构建了 Cox 比例风险回归模型，以通过倾向评分调整估计风险比（HR）。在 704 名参与者中，有 542 名患者在治疗后 10 年仍然存活，在随访期间共有 13 名患者失访。在通过倾向评分和 Gleason 评分调整后，近距离放射治疗和外部放射治疗与 10 年总体生存率降低无关（aHR=1.36，p=0.292 和 aHR=1.44，p=0.222），但在 10 年随访时生化复发率更高（aHR=1.93，p=0.004 和 aHR=2.56，p<0.001）。外部放射治疗的前列腺癌特异性死亡率也更高（aHR=9.37，p=0.015）。与根治性前列腺切除术和外部放射治疗相比，近距离放射治疗在治疗后 10 年控制局限性前列腺癌的有效性方面提供了新的长期结果，其总体生存率与根治性前列腺切除术相似，但生化进展风险更高。这些发现为促进共享临床决策提供了有价值的信息。在 ClinicalTrials.gov 上的研究标识符：NCT01492751。
