Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era.

Abstract

BACKGROUND:

To the authors' knowledge, consensus is lacking regarding the relative long-term efficacy of radical prostatectomy (RP) versus conventional-dose external beam radiation therapy (RT) in the treatment of patients with clinically localized prostate carcinoma.

METHODS:

A retrospective cohort study of 2635 men treated with RP (n = 2254) or conventional-dose RT (n = 381) between 1988-2000 was performed. The primary endpoint was prostate specific antigen (PSA) survival stratified by treatment received and high-risk, intermediate-risk, or low-risk group based on the serum PSA level, biopsy Gleason score, 1992 American Joint Commission on Cancer clinical tumor category, and percent positive prostate biopsies.

RESULTS:

Estimates of 8-year PSA survival (95% confidence interval [95% CI]) for low-risk patients (T1c,T2a, a PSA level < or = 10 ng/mL, and a Gleason score < or = 6) were 88% (95% CI, 85, 90) versus 78% (95% CI, 72, 83) for RP versus patients treated with RT, respectively. Eight-year estimates of PSA survival also favored RP for intermediate-risk patients (T2b or Gleason score 7 or a PSA level > 10 and < or = 20 ng/mL) with < 34% positive prostate biopsies, being 79% (95% CI, 73, 85) versus 65% (95% CI, 58, 72), respectively. Estimates of PSA survival in high-risk (T2c or PSA level > 20 ng/mL or Gleason score > or = 8) and intermediate-risk patients with at least 34% positive prostate biopsies initially favored RT, but were not significantly different after 8 years.

CONCLUSIONS:

Intermediate-risk and low-risk patients with a low biopsy tumor volume who were treated with RP appeared to fare significantly better compared with patients who were treated using conventional-dose RT. Intermediate-risk and high-risk patients with a high biopsy tumor volume who were treated with RP or RT had long-term estimates of PSA survival that were not found to be significantly different.

• Authors: Anthony V D'Amico, Richard Whittington, S Bruce Malkowicz, Kerri Cote, Marian Loffredo, Delray Schultz, Ming-Hui Chen, John E Tomaszewski, Andrew A Renshaw, Alan Wein, Jerome P Richie
• Journal: Cancer (Cancer) Vol. 95 Issue 2 Pg. 281-6 (Jul 15 2002) ISSN: 0008-543X [Print] United States
• PMID: 12124827 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10657

Chemical References

• Prostate-Specific Antigen

Topics

• Carcinoma (blood, mortality, radiotherapy, surgery)
• Disease-Free Survival
• Follow-Up Studies
• Humans
• Male
• Prostate-Specific Antigen (blood)
• Prostatectomy
• Prostatic Neoplasms (blood, mortality, radiotherapy, surgery)
• Retrospective Studies
• Risk Factors
• Survival Rate