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We sought to determine whether one treatment strategy, either brachytherapy or cryotherapy, was superior to the other strategy, either brachytherapy or cryotherapy, for men with clinically localized prostate cancer treated by a single treatment. We performed a retrospective cohort study using the Surveillance, Epidemiology and End Results registry. The primary outcome measure was biochemical failure. The main predictor variables were treatment strategy and the treatment modality used in the brachytherapy and cryotherapy groups. A total of 2949 men met the inclusion criteria. The 5-year overall survival was 98% for patients with either localized prostate cancer or localized prostate cancer with a Gleason score of 6. In a multivariable model, a Gleason score of 6 was associated with a higher risk of biochemical failure (hazard ratio [HR], 1.36; 95% CI, 1.04-1.77; P =.027). When men with Gleason scores of 7 and 8 were considered separately, men with Gleason score 8 had higher biochemical failure rates than men with Gleason score 6. Treatment with cryotherapy alone was associated with a higher risk of biochemical failure (HR, 1.53; 95% CI, 1.07-2.18; P =.018) than treatment with brachytherapy alone. No differences were observed between brachytherapy and cryotherapy in men with Gleason scores of 7 and 8. When treatment modality was taken into account in patients with Gleason scores of 6, no differences in biochemical failure were observed between brachytherapy and cryotherapy. In contrast, when men with Gleason scores of 7 and 8 were considered separately, cryotherapy was associated with a higher risk of biochemical failure than brachytherapy (HR, 1.53; 95% CI, 1.07-2.18). When treatment modality was taken into account in patients with Gleason scores of 7 and 8, no differences in biochemical failure were observed between brachytherapy and cryotherapy.You are here

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