Is modern external beam radiotherapy with androgen deprivation therapy still a viable alternative for prostate cancer in an era of robotic surgery and brachytherapy: A comparison of A ustralian series

We compare the results of modern external‐beam radiotherapy ( EBRT ), using combined androgen deprivation and dose‐escalated intensity‐modulated radiotherapy with MRI ‐ CT fusion and daily image guidance with fiducial markers ( DE ‐ IG ‐ IMRT ), with recently published A ustralian series of brachytherapy and surgery. Methods Five‐year actuarial biochemical disease‐free survival ( bDFS ), metastasis‐free survival ( MFS ) and prostate cancer‐specific survival ( PCaSS ) were calculated for 675 patients treated with DE ‐ IG ‐ IMRT and androgen deprivation therapy ( ADT ). Patients had intermediate‐risk ( IR ) and high‐risk ( HR ) disease. A search was conducted identifying A ustralian reports from 2005 onwards of IR and HR patients treated with surgery or brachytherapy, reporting actuarial outcomes at 3 years or later. Results With a median follow‐up of 59 months, our 5‐year bDFS was 93.3% overall: 95.5% for IR and 91.3% for HR disease. MFS was 96.9% overall (99.0% IR , 94.9% HR ), and PCaSS was 98.8% overall (100% IR , 97.7% HR ). Prevalence of G rade 2 genitourinary and gastrointestinal toxicity at 5 years was 1.3% and 1.6%, with 0.3% G rade 3 genitourinary toxicity and no G rade 3 gastrointestinal toxicity. Eight reports of brachytherapy and surgery were identified. The HDR brachytherapy series' median 5‐year bDFS was 82.5%, MFS 90.0% and PCaSS 97.9%. One surgical series reported 5‐year bDFS of 65.5% for HR patients. One LDR series reported 5‐year bDFS of 85% for IR patients. Conclusions Modern EBRT is at least as effective as modern A ustralian surgical and brachytherapy techniques. All patients considering treatment for localised prostate cancer should be referred to a radiation oncologist to discuss EBRT as an equivalent option.