The following is a summary of “Outcome comparison of radical prostatectomy versus seed brachytherapy for clinically localized prostate cancer using two biochemical recurrence definitions’’ published in the August 2023 issue of Oncology by Zhu et al. 

Researchers performed a retrospective study to investigate the effectiveness of radical prostatectomy (RP) and seed brachytherapy (BT) for localized prostate cancer (LPCa) using two (BCR) definitions. 

The study analyzed data from 1,117 non-metastatic PCa patients treated with RP or BT as part of multimodal therapy at a single tertiary hospital (2007-2021). The study focused on 843 LPCa patients (RP = 737, BT = 106) with post-treatment prostate-specific antigen (PSA) tests.BCR survival was assessed through direct comparison and one-to-one propensity score matching (PSM) analysis. This involved using a surgical definition (PSA ≥ 0.2 ng/ml) for RP and a surgical/Phoenix definition (PSA nadir + 2 ng/ml) for BT. Propensity scores (PS) were computed using multivariable logistic regression considering clinicopathological parameters.

The median follow-up was 43 months for RP patients and 45 months for BT patients. Kaplan-Meier analysis revealed no statistically significant BCR-free survival (BFS) differences between groups using the Phoenix definition for BT (P> 0.05). This held across all D’Amico risk categories. However, with the surgical BT definition, RP demonstrated improved BFS over BT in the entire cohort and risk groups (P< 0.05). After PS adjustment, 192 patients were split evenly (96 each) into RP and BT groups. RP exhibited superior BFS using the surgical definition (P< 0.001) but not with the Phoenix definition (P= 0.609). 

The study found different BCR definitions led to inconsistent BFS results, but RP was better than BT with surgical definition. The exact BCR definition is important for prognostic assessment and will help physicians select treatments. 

Source: pubmed.ncbi.nlm.nih.gov/37635216/