Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer

Cancer. 2011 Jul 1;117(13):2883-91. doi: 10.1002/cncr.25900. Epub 2011 Jan 10.

Abstract

Background: The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT).

Methods: In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification ≥ T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model.

Results: The 10-year cancer-specific survival rate was 92%, 92%, and 88% after RRP, EBRT plus ADT, and EBRT alone, respectively (P = .06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.51-1.18; P = .23) or prostate cancer death (HR, 1.14; 95% CI, 0.68-1.91; P = .61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95% CI, 1.25-2.05; P = .0002).

Conclusions: RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Androgen Antagonists / therapeutic use*
  • Androgens
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Disease Progression
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Proportional Hazards Models
  • Prostate / pathology
  • Prostate / surgery
  • Prostatectomy* / adverse effects
  • Prostatectomy* / methods
  • Prostatectomy* / mortality
  • Prostatic Neoplasms / drug therapy
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / surgery*
  • Quality of Life
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Androgen Antagonists
  • Androgens