Metastasis After Radical Prostatectomy or External Beam Radiotherapy for Patients With Clinically Localized Prostate Cancer: A Comparison of Clinical Cohorts Adjusted for Case Mix

摘要: Purpose We assessed the effect of radical prostatectomy (RP) and external beam radiotherapy (EBRT) on distant metastases (DM) rates in patients with localized prostate cancer treated RP or EBRT at a single specialized center. Patients Methods clinical stages T1c-T3b were intensity-modulated ( 81 Gy) RP. Both cohorts included salvage androgendeprivation therapy for biochemical failure. Salvage was delivered median 13 months after failure compared 69 patients. DM controlling patient age, stage, serum prostate-specific antigen level, biopsy Gleason score, year treatment. Results The 8-year probability freedom from metastatic progression 97% 93% After adjustment case mix, surgery associated reduced risk metastasis (hazard ratio, 0.35; 95% CI, 0.19 to 0.65; P .001). similar cancer–specific mortality 0.32; 0.13 0.80; .015). Rates favorable-risk disease (1.9% difference metastasis-free survival), somewhat intermediate-risk (3.3%), more substantially unfavorable-risk (7.8% progression). Conclusion Metastatic is infrequent men low-risk either EBRT. higher-risk had lower death than These results may be confounded by differences use timing therapy. J Clin Oncol 28:1508-1513. © 2010 American Society Clinical Oncology