Introduction

Radical prostatectomy (RP), intensity modulated radiation therapy (IMRT) and brachytherapy (BT) are three major definitive treatment modalities for localized prostate cancer in recent years. While a lot of technical progress are seen in this decade, patients with localized prostate cancer are often struggling with making a decision of their treatment. It might be due to luck of information in terms of comparing the outcomes among these modalities since only few reports are seen in the literature. _x000D_ We analyzed the results of three treatment modalities using propensity score in a single institution in Japan._x000D_

Methods

From Jan 2004 to Dec 2015, a group of 2272 patients with clinically localized prostate cancer treated with RP (570pts), IMRT (391pts) and BT(1311pts) were identified in our institution. The records of RP(n=410) , IMRT(n=276) and BT(n=1034) patients with a minimum of 2 years of follow-up (total 1720) were reviewed. Propensity scores were calculated using multivariable logistic regression based on the covariates including patient's age, preoperative PSA, Gleason score, number of positive cores, clinical T stage. Each cohort were categorized according to NCCN risk classification and biochemical outcomes plus overall survival were examined. Biochemical failure was defined as RP: PSA >0.2ng/ml, IMRT, BT: nadir PSA level +2ng/ml.

Results

Median follow-up was 75 months (mo) for RP, 57 mo for IMRT and 64 mo for BT patients. After adjustment of propensity scores, a total of 300 patients (150 each) and 468 patients (234 each) were matched for RP vs IMRT cohort and RP vs BT cohort, respectively. Kaplan-Meier analysis did not show any statistically significant differences in terms of overall survival in these two cohorts (RP vs IMRT:p=0.421, RP vs BT:p=0.764). Regarding biochemical failure free survival, there was statistically significant differences in all risk group in RP vs IMRT cohort (High-risk: p=0.000, Intermediate-risk: p=0.001, Low-risk: p=0.007), while significant differences were observed in low (p=0.003), intermediate (p=0.006) risk group among RP vs BT cohort.

Conclusions

Our mid-term outcomes for localized prostate cancer using propensity score analysis demonstrated no significant differences in overall survival. Despite the difference of biochemical failure definition, IMRT and BT improved biochemical failure free survival compared to RP with excellent tumor control.

Funding

None