Abstract
Background
Although brachytherapy is a standard treatment option for patients with high-risk prostate cancer, only a few studies have compared low-dose-rate brachytherapy (LDR-BT) and high-dose-rate brachytherapy (HDR-BT). We applied propensity score-based inverse probability treatment weighting (IPTW) to compare oncological outcomes for LDR-BT and HDR-BT.
Methods
We retrospectively assessed prognosis in 392 patients with high-risk localized prostate cancer who had undergone brachytherapy plus external beam radiation. IPTW was applied to adjust the Kaplan–Meier survival analyses and Cox proportional hazards regression analyses, with the goal of minimizing bias from patient background.
Results
The IPTW-adjusted Kaplan–Meier survival analyses showed no statistically significant differences for time to biochemical recurrence, clinical progression, castration-resistant prostate cancer, or death from any cause. The IPTW-adjusted Cox regression analyses also showed that the modality of brachytherapy was not an independent factor in these oncological outcomes. Notably, the two groups differed regarding complications; LDR-BT was associated with a higher rate of acute grade ≥ 2 GU toxicity, and late grade 3 toxicity was noted only in HDR-BT.
Conclusion
Our analysis of long-term outcomes in patients with high-risk localized prostate cancer shows no significant differences in oncological outcomes between LDR-BT and HDR-BT, but some differences in toxicity, and offers patients and clinicians useful information in deciding management strategies for high-risk localized prostate cancer.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Change history
09 October 2023
A Correction to this paper has been published: https://doi.org/10.1007/s10147-023-02415-w
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Acknowledgements
This study was supported in part by a Grant, SHIP0804 NCT00664456. We thank Dr. Takaya Sasaki, Department of Nephrology and Hypertension, The Jikei University School of Medicine for critical discussion and revision of this manuscript. English-language editorial support was provided by Lee Seaman of Seaman Medical, Inc., Bellingham WA USA.
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Imai, Y., Urabe, F., Iwatani, K. et al. Comparison of outcomes in high-risk prostate cancer patients treated with low-/high-dose-rate brachytherapy plus external beam radiotherapy. Int J Clin Oncol 28, 698–706 (2023). https://doi.org/10.1007/s10147-023-02314-0
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DOI: https://doi.org/10.1007/s10147-023-02314-0