Implante permanente de sementes de iodo e prostectomia radical em portadores de câncer de próstata: análise comparativa de uma coorte de base hospitalar

Abstract

This study aimed to analyze and compare the biochemical relapse-free survival at five years and prognostic factors in patients with prostate cancer undergoing radical surgery or brachytherapy. We analyzed 129 patients with prostate cancer, these 64 underwent brachtherapy with permanent seeds implantation and 75 patients were treated with radical prostatectomy, from January 2002 to December 2005 in a private hospital network in the city of Juiz de Fora-MG. The main variables analyzed were collected from medical records and were: age, date of birth, initial PSA, Gleason score of prostate biopsy and of surgical specimens, clinical and pathologic staging on surgical cases, the prostate volume pre-planning and at the time of brachytherapy, seed activity of lodine 125 and serial measurements of PSA after treatment. Patients were classified according to D’Amico, at risk groups; low, intermediate and high. The biochemical recurrence was defined as PSA levels>0.4 ng/ml for cases of radical prostatectomy and three consecutive elevations of PSA for patients implanted (ASTRO). For the study of the effect of the treatment on biochemical relapse-free survival Kaplan-Meier curves were generated, and log rank test was used to determine the differences among the curves. The influence of multiple variables in the biochemical relapse-free survival as age, initial PSA, Gleason score, staging and risk category was estimated by Cox regression. In the first article, was observed rate of biochemical relapse-free survival superior (p = 0.0056) for patients undergoing brachytherapy 79.70% (CI95% :66,87-87, 99) when compared with patients undergoing surgery 44.30% (CI95% :23,28-63, 47) and were identified as prognostic factors independently associated with survival free of biochemical recurrence modality therapy (HR = 3.33, CI95% :1,41-7 88), serum levels of IPSA (HR = 2.54, CI95% :1,11-5, 78) and risk category (HR = 4.18, CI95% :1,89-9, 23). In the second article, which evaluated only the patients who underwent brachytherapy, there was a rate of biochemical relapse-free survival at five years, significantly higher (p = 0.0012) for patients with low-risk group 91.6% (CI 95% :75,92-97, 24), when compared with that of patients in the intermediate/high risk group 59.19% (CI95% :36,00-76, 40).The biochemical relapse-free survival was also significantly higher in patients with IPSA ≤ 10ng/ml (p = 0.0084) and Gleason score ≤ 6 on prostate biopsy (p = 0.0057). In multivariate analysis, the risk of biochemical failure also remained

higher in patients who belonged to the group of moderate / high risk and patients with IPSA more than 10ng/ml. Data from biochemical relapse-free survival at five years for the patients of this analysis were comparable to literature.