Ten-Year Treatment Outcomes of Radical Prostatectomy Vs External Beam Radiation Therapy Vs Brachytherapy for 1503 Patients With Intermediate-risk Prostate Cancer.

Objective: To compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate-risk prostate cancer (IRPC).

Methods: A retrospective analysis using propensity score matching was performed on 1503 IRPC patients who underwent treatment from 2004 to 2007. Eight hundred and nineteen underwent RP, 574 underwent EBRT to a median dose of 75.3 Gray, and 110 underwent BT using Iodine-125. Biochemical failure was defined by the American Urological Association definition of failure for RP, and the Phoenix definition for EBRT and BT.

Results: Median follow-up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy was given in 0.6% of RP, 58.9% of EBRT, and 12.7% of BT patients, P <.0001. Only 14% of BT received supplemental external radiation. The adjusted 10-year freedom from biochemical failure was 80.2% for BT vs 57.1% for RP vs 57.0% for EBRT, P = .0003. Subset analysis of unfavorable IRPC also showed improved freedom from biochemical failure with BT, P <.0001. There were no significant differences in metastases-free survival or prostate cancer-specific survival after adjusting for age and Charlson comorbidity index.

Conclusion: BT using Iodine-125, used alone or in combination with supplemental external radiation, is a reasonable treatment option for IRPC patients, yielding equivalent rates of metastases-free survival and prostate cancer-specific survival.