Brachytherapy versus prostatectomy in localized prostate cancer: results of a French multicenter prospective medico-economic study.
OBJECTIVE
To prospectively compare health-related quality of life (HRQOL), patient-reported treatment-related symptoms, and costs of iodine-125 permanent implant interstitial brachytherapy (IB) with those of radical prostatectomy (RP) during the first 2 years after these treatments for localized prostate cancer.


METHODS
A total of 435 men with localized low-risk prostate cancer, from 11 French hospitals, treated with IB (308) or RP (127), were offered to complete the European Organization for Research and Treatment of Cancer core Quality of Life Questionnaire QLQ-C30 version 3 (EORTC QLQ-C30) and the prostate cancer specific EORTC QLQ-PR25 module before and at the end of treatment, 2, 6, 12, 18, and 24 months after treatment. Repeated measures analysis of variance and analysis of covariance were conducted on HRQOL changes. Comparative cost analysis covered initial treatment, hospital follow-up, outpatient and production loss costs.


RESULTS
Just after treatment, the decrease of global HRQOL was less pronounced in the IB than in the RP group, with a 13.5 points difference (p < 0.0001). A difference slightly in favor of RP was observed 6 months after treatment (-7.5 points, p = 0.0164) and was maintained at 24 months (-8.2 points, p = 0.0379). Impotence and urinary incontinence were more pronounced after RP, whereas urinary frequency, urgency, and urination pain were more frequent after IB. Mean societal costs did not differ between IB (8,019 euros at T24) and RP (8,715 euros at T24, p = 0.0843) regardless of the period.


CONCLUSIONS
This study suggests a similar cost profile in France for IB and RP but with different HRQOL and side effect profiles. Those findings may be used to tailor localized prostate cancer treatments to suit individual patients' needs.
Buron
Catherine
C
Department of Medical Information, Institut Curie, Paris, France.
Le Vu
Beatrice
B
Cosset
Jean-Marc
JM
Pommier
Pascal
P
Peiffert
Didier
D
Delannes
Martine
M
Flam
Thierry
T
Guerif
Stephane
S
Salem
Naji
N
Chauveinc
Laurent
L
Livartowski
Alain
A
D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology; D005602:France; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D017048:Health Care Costs; D006304:Health Status; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000209:etiology
D007496:Iridium Radioisotopes