Biochemical Outcome After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer

摘要: Context.—Interstitial radiation (implant) therapy is used to treat clinically localized adenocarcinoma of the prostate, but how it compares with other treatments is not known.Objective.—To estimate control prostate-specific antigen (PSA) after radical prostatectomy (RP), external beam (RT), or implant without neoadjuvant androgen deprivation in patients clinically localized prostate cancer.Design.—Retrospective cohort study outcome data compared using Cox regression multivariable analyses.Setting and Patients.—A total 1872 men treated between January 1989 October 1997 with an RP (n=888) without neoadjuvant deprivation therapy (n=218) at Hospital University Pennsylvania, Philadelphia, or RT (n=766) Joint Center for Radiation Therapy, Boston, Mass, were enrolled.Main Outcome Measure.—Actuarial freedom from PSA failure (defined as outcome).Results.—The relative risk (RR) low-risk (stage T1c, T2a level ≤10 ng/mL Gleason score ≤6) RT, implant plus therapy, was 1.1 (95% confidence interval [CI], 0.5-2.7), 0.5 (95% CI, 0.1-1.9), CI, 0.3-3.6), respectively, those RP. The RRs intermediate-risk T2b Gleason score 7 >10 ≤20 ng/mL) high-risk (stage T2c >20 ≥8) compared with were 3.1 1.5-6.1) 3.0 1.8-5.0), respectively. The addition did improve PSA outcome resulted a that statistically different results obtained intermediate-risk patients. These unchanged when stratified using the traditional rankings biopsy scores 2 through 4 vs 5 through 6 8 10.Conclusions.—Low-risk had estimates 5-year treatment with RP, RT, that were statistically different, whereas intermediate- patients treated better then by implant. Prospective randomized trials are needed verify these findings.