Combined EBRT and Brachytherapy vs Radical Prostatectomy With Adjuvant Radiation Therapy for Prostate Cancer

[Balsam01]

TAKE-HOME MESSAGE

•While existing studies have shown better oncologic outcomes with external beam radiation therapy with brachytherapy boost compared with radical prostatectomy, there have been limited data regarding combination radiation therapy versus prostatectomy with adjuvant radiation. The authors of this study used the National Cancer Data Base to show that there was no significant difference in 5-year overall survival in patients receiving combination radiation therapy versus prostatectomy with adjuvant radiation (87.0% vs 86.7%; P=.220). Likewise, no difference was seen in prostate cancer–specific mortality.

•These data are helpful in suggesting oncologically appropriate treatment strategies for men with Gleason 9–10 prostate cancer. They do not, however, capture the toxicity of these treatments, which may be more significant in a multimodal approach.

- Michael H. Johnson, MD

PURPOSE

It remains controversial whether external beam radiation therapy with a brachytherapy boost provides oncologic outcomes equivalent to those of radical prostatectomy with or without adjuvant radiation therapy in men with Gleason 9-10 prostate cancer. We compared external beam radiation therapy plus brachytherapy to radical prostatectomy plus adjuvant radiation therapy of Gleason 9-10 prostate cancer in terms of overall survival and prostate cancer specific mortality in 2 large national databases.

MATERIALS AND METHODS

Using the NCDB (National Cancer Database) and the SEER (Surveillance, Epidemiology, and End Results) database we identified 4,367 and 2,276 patients, respectively, diagnosed with clinical T1-T3N0M0, Gleason 9-10, prostate specific antigen 0 to 40 ng/ml prostate cancer managed by external beam radiation therapy plus brachytherapy or radical prostatectomy plus adjuvant radiation therapy. We compared overall survival and prostate cancer specific mortality in the 2 databases using inverse probability of treatment weighted multivariable Cox proportional hazards regression modeling after accounting for clinical and demographic factors.

RESULTS

Median followup in the NCDB and SEER cohorts was 6.0 years and 5.8 years, respectively. In the NCDB cohort there was no significant difference in 5-year overall survival between radical prostatectomy plus adjuvant radiation therapy vs external beam radiation therapy plus brachytherapy (86.7% vs 87.0%, AHR 1.10, 95% CI 0.95-1.27, p=0.220). Results were unchanged when including only patients who received hormonal therapy. In the SEER cohort there was no difference in 5-year prostate cancer specific mortality (6.0% vs 5.7%, AHR 1.22, 95% CI 0.0.88-1.71, p=0.234). There was no significant interaction between patient age (65 years or greater vs less than 65) and treatment modality in the NCDB or SEER cohorts.

CONCLUSIONS

In men with Gleason 9-10 prostate cancer multimodality surgical therapy is equivalent to external beam radiation therapy plus brachytherapy.

The Journal of Urology

Combined External Beam Radiation Therapy and Brachytherapy Versus Radical Prostatectomy With Adjuvant Radiation Therapy of Gleason 9-10 Prostate Cancer

J Urol 2019 May 30;[EPub Ahead of Print], V Muralidhar, BA Mahal, S Butler, N Lamba, DD Yang, J Leeman, AV D'Amico, PL Nguyen, QD Trinh, PF Orio, MT King

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

[VictoryPC]

I agree. Keep your parts.

[nobaday]

Interesting post thanks.

I’m in Canada and was reading today’s post on the primary tumour.

My PSA coming up to 24 months on Zytiga is undetectable at 0.01.

Even so I asked for radiation to the prostate a couple of months ago but as I had a bunch of Mets ( considered high burden) there is no way under SOC I can get radiation to the prostate.

But I am thinking it could not harm to go to the US or elsewhere to get private radiation and Brachytherapy boost as really there is no good data to say whether or not this could extend overall survival.