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• W2094549306 abstract "You have accessJournal of UrologyProstate Cancer: Advanced1 Apr 2011886 LONG-TERM SURVIVAL AFTER SURGERY VERSUS EXTERNAL BEAM RADIOTHERAPY FOR HIGH-RISK PROSTATE CANCER Stephen Boorjian, R. Jeffrey Karnes, Rosalia Viterbo, Laureano Rangel, Eric Bergstralh, Eric Horwitz, Michael Blute, and Mark Buyyounouski Stephen BoorjianStephen Boorjian Rochester, MN More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes Rochester, MN More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , Laureano RangelLaureano Rangel Rochester, MN More articles by this author , Eric BergstralhEric Bergstralh Rochester, MN More articles by this author , Eric HorwitzEric Horwitz Philadelphia, PA More articles by this author , Michael BluteMichael Blute Rochester, MN More articles by this author , and Mark BuyyounouskiMark Buyyounouski Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.752AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of patients with high-risk prostate cancer remains in debate, and prospective clinical trials comparing treatment outcomes are lacking. We evaluated the survival of patients with high-risk disease following radical prostatectomy (RP) and external beam radiation therapy (RT) during the PSA era. METHODS We identified 1,238 men who underwent RP and 609 men treated with RT between 1988–2004 who had a pretreatment prostate specific antigen (PSA) ≥ 20 ng/mL, biopsy Gleason score 8–10, or clinical stage ≥ T3. The impact of treatment modality on cancer-specific (CSS) and overall survival (OS) was analyzed using Cox proportional hazard regression models controlling for patient age, Charlson comorbidity index (CCI), and clinicopathologic tumor variables. RESULTS Patients treated with RT were older (p<0.0001), had a greater pretreatment PSA (p=0.02), higher biopsy Gleason score (p<0.0001), and more advanced clinical stage (p<0.0001). In total, 344 (57%) men who underwent RT were treated with adjuvant androgen deprivation therapy (ADT), while 418 (34%) men who underwent RP received adjuvant ADT and 136 (11%) received adjuvant RT. Median follow-up was 10.2, 6.0, and 7.2 years after RP, RT + ADT, and RT alone. Estimated 10-year CSS following RP and RT + ADT was equivalent (92%), and was modestly better than RT alone (88%; p=0.06). 10-year OS was significantly improved after RP (77%) versus RT + ADT (67%) or RT alone (52%; p<0.001). On multivariate analysis (Table), patients who underwent RT alone had a significantly increased risk of death from prostate cancer (p=0.0006) and overall mortality (p<0.0001) compared to patients treated with RP. No significant difference in the risk of cancer death was seen between RT + ADT and RP (p=0.90); however, men who received RT + ADT had a greater than 50% increased risk of overall mortality versus men who underwent RP (p=0.0005). MULTIVARIATE COX MODEL FOR PREDICTORS OF DEATH FROM PROSTATE CANCER (LEFT) AND ALL-CAUSE MORTALITY (RIGHT) IN MEN WITH HIGH-RISK PROSTATE CANCER VARIABLE HR 95% CI p Value HR 95% CI p Value Age 0.99 0.97, 1.01 0.46 1.05 1.04, 1.07 <0.0001 CCI 1.10 0.91, 1.33 0.33 1.25 1.15, 1.35 <0.0001 Log2 PSA 1.21 1.08, 1.36 0.001 1.12 1.05, 1.19 0.0007 Biopsy Gleason score 1.56 1.36, 1.80 1.22 1.13, 1.32 <0.0001 Clinical stage (cT2 vs cT1c) 2.14 1.18, 3.86 0.01 1.19 0.93, 1.51 0.16 Clinical stage (cT3/4 vs cT1c) 2.95 1.62, 5.35 0.0004 1.29 1.01, 1.66 0.04 Treatment (RT alone vs RP) 2.25 1.42, 3.56 0.0006 2.18 1.73, 2.75 <0.0001 Treatment (RT + ADT vs RP) 1.03 0.62, 1.71 0.90 1.54 1.21, 1.96 0.0005 CONCLUSIONS RP and RT + ADT provide similar long-term cancer control for patients with high-risk disease, although the risk of all-cause mortality was greater after RT + ADT. As surgery provides pathologic staging to guide the selected use of secondary therapies, prospective studies evaluating the differing impact of treatments on quality of life and non-cancer mortality are necessary to determine the optimal management approach to these men. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e355 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Boorjian Rochester, MN More articles by this author R. Jeffrey Karnes Rochester, MN More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author Laureano Rangel Rochester, MN More articles by this author Eric Bergstralh Rochester, MN More articles by this author Eric Horwitz Philadelphia, PA More articles by this author Michael Blute Rochester, MN More articles by this author Mark Buyyounouski Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2094549306 title "886 LONG-TERM SURVIVAL AFTER SURGERY VERSUS EXTERNAL BEAM RADIOTHERAPY FOR HIGH-RISK PROSTATE CANCER" @default.
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