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The prognostic significance of the clinical T stage and Grade Group in patients with locally advanced prostate cancer treated via high-dose-rate brachytherapy and external beam radiation

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Abstract

Background

Although the optimal management of locally advanced prostate cancer (PCa) remains unclear, local definitive therapy, thus combined radiotherapy and androgen deprivation, is one option. We evaluated the long-term outcomes of patients with locally advanced PCa who underwent high-dose-rate brachytherapy (HDR-BT) and external beam radiation therapy (EBRT).

Methods

We retrospectively analyzed 173 patients with locally advanced PCa (cT3a-4N0-1M0) who underwent HDR-BT and EBRT. We employed Cox’s proportional hazards models to identify pre-treatment predictors of oncological outcomes. Treatment outcomes (biochemical recurrence-free survival [BCRFS], clinical progression-free survival [CPFS], and castration-resistant prostate cancer-free survival [CRPCFS] were compared according to the combination of the pre-treatment predictors.

Results

The 5-year BCRFS, CPFS, and CRPCFS rates were 78.5, 91.7, and 94.4% respectively; there were two PCa deaths. Multivariate analysis revealed that the clinical T stage (cT3b and cT4) and Grade Group (GG) 5 status were independent risk factors for poor BCRFS, CPFS, and CRPCFS. In the GG ≤ 4 group, the Kaplan–Meier curves for BCRFS, CPFS, and CRPCFS revealed excellent outcomes. However, in the GG5 group, patients with cT3b and cT4 PCa evidenced significantly poorer oncological outcomes than those with cT3a PCa.

Conclusion

The clinical T stage and GG status were significantly prognostic of oncological outcomes in patients with locally advanced PCa. In patients of GG ≤ 4 PCa, HDR-BT was effective even in patients with cT3b or cT4 PCa. However, in patients with GG5 PCa, careful monitoring is essential, particularly of patients with cT3b or cT4 PCa.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank Textcheck Inc. for English language editing.

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Author notes

  1. Soshi Kadena and Fumihiko Urabe contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Soshi Kadena, Fumihiko Urabe, Kosuke Iwatani, Hirotaka Suzuki, Yu Imai, Kojiro Tashiro, Shunsuke Tsuzuki, Mariko Honda, Yusuke Koike, Tatsuya Shimomura, Kenta Miki & Takahiro Kimura

  2. Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan

    Manabu Aoki

  3. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan

    Shun Sato & Hiroyuki Takahashi

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  1. Soshi Kadena
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Correspondence to Fumihiko Urabe.

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Kadena, S., Urabe, F., Iwatani, K. et al. The prognostic significance of the clinical T stage and Grade Group in patients with locally advanced prostate cancer treated via high-dose-rate brachytherapy and external beam radiation. Int J Clin Oncol 28, 1092–1100 (2023). https://doi.org/10.1007/s10147-023-02359-1

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  • DOI: https://doi.org/10.1007/s10147-023-02359-1

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