Barry W Goy1, Raoul Burchette2, Margaret S Soper3, Tangel Chang4, Harry A Cosmatos3. 1. Department of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA. Electronic address: barry.w.goy@kp.org. 2. Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA. 3. Department of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA. 4. Department of Radiation Oncology, University Hospital Cleveland Medical Center, Cleveland, OH.
Abstract
OBJECTIVE: To compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate-risk prostate cancer (IRPC). METHODS: A retrospective analysis using propensity score matching was performed on 1503 IRPC patients who underwent treatment from 2004 to 2007. Eight hundred and nineteen underwent RP, 574 underwent EBRT to a median dose of 75.3 Gray, and 110 underwent BT using Iodine-125. Biochemical failure was defined by the American Urological Association definition of failure for RP, and the Phoenix definition for EBRT and BT. RESULTS: Median follow-up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy was given in 0.6% of RP, 58.9% of EBRT, and 12.7% of BT patients, P <.0001. Only 14% of BT received supplemental external radiation. The adjusted 10-year freedom from biochemical failure was 80.2% for BT vs 57.1% for RP vs 57.0% for EBRT, P = .0003. Subset analysis of unfavorable IRPC also showed improved freedom from biochemical failure with BT, P <.0001. There were no significant differences in metastases-free survival or prostate cancer-specific survival after adjusting for age and Charlson comorbidity index. CONCLUSION: BT using Iodine-125, used alone or in combination with supplemental external radiation, is a reasonable treatment option for IRPC patients, yielding equivalent rates of metastases-free survival and prostate cancer-specific survival.
OBJECTIVE: To compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate-risk prostate cancer (IRPC). METHODS: A retrospective analysis using propensity score matching was performed on 1503 IRPC patients who underwent treatment from 2004 to 2007. Eight hundred and nineteen underwent RP, 574 underwent EBRT to a median dose of 75.3 Gray, and 110 underwent BT using Iodine-125. Biochemical failure was defined by the American Urological Association definition of failure for RP, and the Phoenix definition for EBRT and BT. RESULTS: Median follow-up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy was given in 0.6% of RP, 58.9% of EBRT, and 12.7% of BT patients, P <.0001. Only 14% of BT received supplemental external radiation. The adjusted 10-year freedom from biochemical failure was 80.2% for BT vs 57.1% for RP vs 57.0% for EBRT, P = .0003. Subset analysis of unfavorable IRPC also showed improved freedom from biochemical failure with BT, P <.0001. There were no significant differences in metastases-free survival or prostate cancer-specific survival after adjusting for age and Charlson comorbidity index. CONCLUSION: BT using Iodine-125, used alone or in combination with supplemental external radiation, is a reasonable treatment option for IRPC patients, yielding equivalent rates of metastases-free survival and prostate cancer-specific survival.
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