[Comparison of clinical outcomes between radical prostatectomy and permanent prostate brachytherapy in patients with oligometastatic prostate cancer: A propensity score-matched study].

Authors

Dandan Su, Baishun Li, Ruotao Xiao, Fan Zhang, Shudong Zhang

Published in

Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences. Volume 58. Issue 4. Pages 787-793. Aug 18, 2026.

Abstract

To compare radical prostatectomy (RP) versus permanent prostate brachytherapy (PPB) as primary local treatment modalities in delaying disease progression to castration-resistant prostate cancer (CRPC) among patients with oligometastatic prostate cancer (omPCa) receiving standard androgen deprivation therapy (ADT), and to provide clinical evidence for individualized treatment strategies.
We performed a retrospective cohort analysis of 88 patients diagnosed with omPCa (defined as ≤5 metastatic lesions) at a single tertiary center between April 2011 and August 2019. All the patients, after receiving either RP (n=62) or PPB (n=26), were placed on a regimen of continuous ADT. To address significant baseline disparities-notably in patient age, presenting prostate-specific antigen (PSA) levels, and nodal disease burden: A 1 ∶ 1 propensity score matching (PSM) protocol was implemented. Matching variables included age at diagnosis, baseline PSA, clinical T stage (≤T2c vs. ≥ T3), and nodal status (N0 vs. N1). The primary study endpoint was the time interval from ADT initiation to CRPC development, as defined by the prostate cancer working group 3 (PCWG3) criteria. Survival outcomes were compared using Kaplan-Meier curves and the Log-rank test. Independent risk factors for progression were identified through both univariate and multivariate Cox proportional hazards regression analyses.
Prior to PSM, the RP and PPB groups exhibited significant differences in key prognostic factors: the PPB group was older (mean 73.2 vs. 68.1 years, P=0.002), had a higher median PSA (31.2 vs. 9.8 μg/L, P=0.002), and had a greater incidence of lymph node involvement (42.3% vs. 12.9%, P=0.006). Following PSM, a balanced cohort of 36 patients (18 in each group) was achieved. Over a median follow-up of 30.5 months (range: 3.2 to 113.4 months), 15 patients (17.0%) developed CRPC, with 8 events occurring in the PPB group and 7 in the RP group. Survival analysis demonstrated a consistent, statistically significant advantage for RP. In the pre-matched cohort, the RP group showed a significantly delayed progression to CRPC (Log-rank P=0.033, HR=3.38, 95%CI: 1.10-10.40), with a median CRPC-free survival of 80.0 months for PPB and not reached for RP. In the matched cohort, the survival advantage of RP was more pronounced (Log-rank P=0.032, HR=4.60, 95%CI: 1.14-18.49), with a median CRPC-free survival of 80.0 months for PPB and not reached for RP. Multivariate Cox regression, adjusting for T and N stages, confirmed treatment modality as a powerful independent predictor. Patients treated with PPB faced an 8.56-fold higher risk of progression compared with those treated with RP (HR=8.56, 95%CI: 1.51-48.64, P=0.015). Advanced primary tumor stage (≥T3) was also identified as a significant independent risk factor (HR=10.29, 95%CI: 1.75-60.57, P=0.010).
For patients with omPCa receiving ADT, the choice of local therapeutic intervention significantly impacts the time to CRPC. Radical prostatectomy is associated with a markedly longer delay in disease progression to the castration-resistant state compared with permanent prostate brachytherapy, with the treatment modality itself serving as a strong independent prognostic factor. These findings underscore the importance of considering the type of local therapy in the multimodal management of omPCa and provide a rationale for individualized treatment planning. Prospective, randomized trials are necessary to validate these observations and further define optimal therapeutic paradigms.

PMID:
42493446
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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