Comparison of Radical Prostatectomy and Iodine 125 Interstitial Radiotherapy for the Treatment of Clinically Localized Prostate Cancer: A 7-Year Biochemical (PSA) Progression Analysis

• Published in: Urology (Ridgewood, N.J.) N.J.), 1998-06, Vol.51 (6), p.884-890
• Main Authors: Polascik, Thomas J, Pound, Charles R, DeWeese, Theodore L, Walsh, Patrick C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brachytherapy; Disease Progression; Humans; Iodine Radioisotopes - therapeutic use; Male; Middle Aged; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Time Factors
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(98)00153-8

Objectives. To evaluate the relative efficacy of brachytherapy to radical prostatectomy, we compared biochemical progression rates from a published series of men who underwent iodine 125 ( 125I) interstitial radiotherapy for localized prostate cancer to a similar group of men who underwent anatomic radical prostatectomy using appropriate end points. Methods. Seventy-six men who underwent anatomic radical prostatectomy between 1988 and 1990 were carefully matched for Gleason score and clinical stage to a recently reported contemporary series of patients treated at another institution with 125I brachytherapy without adjuvant treatment. The definition of biochemical progression was a serum PSA level greater than 0.2 ng/mL after anatomic radical prostatectomy and greater than 0.5 ng/mL for brachytherapy-treated patients. Results. The 7-year actuarial PSA progression-free survival following anatomic radical prostatectomy was 97.8% (95% confidence interval [CI], 85.6% to 99.7%) for this group of men selected to match the brachytherapy group, compared to 79% (95% CI not published) for men treated with 125I interstitial radiotherapy. Conclusions. Using comparative end points for biochemical-free progression, failure rates may be higher following 125I interstitial radiotherapy compared to anatomic radical prostatectomy. These data provide a better comparison of biochemical progression than previously published studies and emphasize the need for caution in interpreting the relative efficacy of brachytherapy in controlling localized prostate cancer.