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In localized prostate cancer, data
comparing low-dose-rate external beam radiation therapy (EBRT-LDR) with radical prostatectomy (RP) are lacking.
Therefore, to make better clinical decisions, the investigators compared patient-reported outcomes (PROs) with 5 years of follow-up after treatment with the two regimens for clinical reference
.
The results were published in The Journal of Urology, and are compiled below
.
In foreign countries, RP is a common treatment
for intermediate- and high-risk localized prostate cancer.
With the development of medical technology, there is growing interest in dose escalation EBRT, LDR brachytherapy, and androgen deprivation therapy (ADT
).
However, prospective studies comparing EBRT, brachytherapy (BT), and RP are scarce, making assessing functional outcomes and health-related quality of life (HRQoL) particularly important
for patients.
The investigators conducted this prospective study to evaluate PROs
that patients were followed for more than 5 years after treatment with RP or EBRT-LDR.
Between 2011 and 2012, patients with localized prostate cancer under 80 years of age were included in the study with the inclusion criteria of prostate-specific antigen (PSA) <50ng/dL and pathologically confirmed prostate cancer within 6 months of participating in the study).
<b10> Subsequently, follow-up at baseline, 6 months, 1 year, 3 years, and 5 years was performed to obtain PROs and demographic data and were analyzed
using a regression model.
The study population included 112 patients treated with EBRT-LDR and 1553 patients
treated with RP.
After 5 years of follow-up, urinary tract irritation/urinary tract obstruction was more pronounced in the EBRT-LDR-treated group (adjusted mean score difference -5.
0, 95% CI -8.
7, -1.
3; p=0.
008 at 5 years) but better in urinary incontinence (13.
3, 95% CI 7.
7 to 18.
9; p<0.
001 at 5 years).
<b11>
Urinary dysfunction was similar in both groups (P>0.
4 at all time points).
After 5 years of follow-up, patients in the EBRT-LDR group had worse bowel function compared with RP (-4.
0 95% CI -6.
9, -1.
1; p=0.
006 at 5 years).
However, sexual function was better at one year in the EBRT-LDR group (12.
0, 95% CI 6.
5, 17.
5; p<0.
001), although there was insufficient evidence to reject the hypothesis<b12> that there was no difference at three or five years.
Fig.
1 Comparison of prostate cancer clinical comprehensive extended index scale scores over 5 years of EBRT-LDR and surgery
After 5 years of follow-up, the study found that patients in the EBRT-LDR group had more severe urinary irritation/obstruction, worse bowel function, but less
urinary incontinence symptoms compared with RP.
These PROs data may help patients clarify treatment expectations and inform
treatment options for localized prostate cancer.
References
1.
De B, Pasalic D, Barocas DA, Wallis CJD, Huang LC, Zhao Z, Koyama T, Tang C, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O'Neil BB, Kaplan SH, Greenfield S, Penson DF, Hoffman KE.
Patient-Reported Outcomes after External Beam Radiotherapy with Low Dose-Rate Brachytherapy Boost versus Radical Prostatectomy for Localized Prostate Cancer: Five-Year Results from a Prospective Comparative Effectiveness Study.
J Urol.
2022 Aug 25.
Edit: LR
Review: LR
Execution: LR
