Objective To compare the prognosis between radical prostatectomy(RP)and low-dose-rate brachytherapy(LDR-BT)in the treatment of localized prostate cancer.Methods A to-tal of 452 patients with localized prostate cancer who underwent RP and 108 patients treated with LDR-BT were included in the clinical database from January 2010 to December 2022 in Second Affili-ated Hospital of Soochow University.Biochemical recurrence in the RP group was defined as 2 con-secutive PSAs>0.2 ng/ml during postoperative follow-up,while biochemical recurrence in the LDR-BT group was defined as an increase of 2.0 ng/ml after PSA decreased to the lowest point dur-ing postoperative follow-up.The Kaplan-Meier method was used to evaluate and analyze the survival curves of the two groups.After adjusting for propensity score matching,198 patients(99 patients in each group)were selected,and the differences in survival curves between the two groups were fur-ther analyzed and compared by Log-rank test,Cox regression model was established to analyze the factors affecting the biochemical recurrence-free survival(BRFS).Results The follow-up time of 560 patients included in this study was 10-156 months,and the median follow-up time was 68 months.Fifty-eight patients in the RP group had biochemical recurrence,and BRFS was 88.3%and 85.7%at 3 and 5 years after surgery,respectively.There were 8 patients in the LDR-BT group with biochemical recurrence,and BRFS at 3 and 5 years after surgery were 94.1%and 92.6%,respectively.There was no significant difference in BRFS between the two groups(P=0.080).For 198 patients with localized prostate cancer after propensity score matching,the results showed that the 5-year OS of the LDR-BT group and the RP group were 90.3%and 92.8%,respectively,and there was no significant difference in OS between the two groups(P=0.295).The 5-year total BRFS of the LDR-BT group and the RP group were 93.9%and 82.8%,respectively,and BRFS of the LDR-BT group was higher than that of the RP group(P=0.017).Among the patients with tPSA≤21.67 ng/ml(P=0.026),prostate volume≤38.4 ml(P=0.036),prostate-specific antigen density≤0.695 ng/ml2(P=0.009),BMI≤22.49 kg/m2(P=0.008),and clinical stage T1c-T2b(P<0.05),BRFS in the LDR-BT group was significantly higher than that in the RP group.Multivariate Cox regression analysis showed that LDR-BT treatment(HR=2.887;95%CI:1.107-7.528;P=0.030)was significantly associated with the increase in BRFS.Conclusions For patients with localized prostate cancer,BRFS in the LDR-BT group is significantly higher than that in the RP group.Patients with localized prostate cancer,especially those who are elderly,are more suitable for LDR-BT.
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