Efficacy of brachytherapy combined with endocrine therapy and external beam radiotherapy in the treatment of intermediate and high-risk localized prostate cancer.

Purpose: To explore the efficacy and safety of brachytherapy combined with endocrine therapy (ET) and external beam radiotherapy (EBRT) in the treatment of patients with intermediate- and high-risk localized prostate cancer (PCa).

Methods: A total of 128 patients with intermediate- and high-risk localized PCa treated in our hospital, were included, encompassing 64 cases undergoing brachytherapy combined with ET (control group), and 64 cases undergoing intensity-modulated EBRT on the above basis (combination group). The clinical efficacy, adverse reactions, the serum prostate specific antigen (PSA) level before and after treatment, maximum urinary flow rate (Qmax), and expanded prostate cancer index composite (EPIC) score were compared between the two groups. The overall survival (OS) of patients was analyzed using the Kaplan-Meier method and log-rank test.

Results: After treatment, the EPIC scores of urinary function, intestinal function, sexual function and hormone function declined significantly in both groups, and they were significantly higher in the combination group than in the control group. At 12 months after treatment, the combination group had an obviously lower serum PSA level, and obviously higher Qmax than the control group. All patients were followed up for 12-60 months. In the combination and control group, OS was 87.5% and 81.3%, disease-specific survival (DSS) was 89.1% and 78.1%, the biochemical progression-free survival (bPFS) was 76.6% and 60.9%, and distant metastasis free survival (DMFS) was 87.5% and 71.9%, respectively. Log-rank test showed no statistically significant differences in OS and DSS between the two groups, but both bPFS and DMFS in the combination group were remarkably superior compared with the control group.

Conclusions: Brachytherapy combined with ET and EBRT has definite efficacy in intermediate- and high-risk localized PCa, which can significantly improve the physiological function, raise the quality of life of patients, and effectively control the disease progression.