Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era

被引:274
作者
D'Amico, AV
Whittington, R
Malkowicz, SB
Cote, K
Loffredo, M
Schultz, D
Chen, MH
Tomaszewski, JE
Renshaw, AA
Wein, A
Richie, JP
机构
[1] Brigham & Womens Hosp, Dept Radiat Oncol, Boston, MA 02115 USA
[2] Dana Farber Canc Inst, Boston, MA 02115 USA
[3] Brigham & Womens Hosp, Dept Urol, Boston, MA 02115 USA
[4] Brigham & Womens Hosp, Dept Pathol, Boston, MA 02115 USA
[5] Hosp Univ Penn, Dept Pathol, Philadelphia, PA 19104 USA
[6] Univ Connecticut, Dept Biostat, Farmington, CT USA
[7] Millersville Univ Pennsylvania, Dept Math, Millersville, PA 17551 USA
[8] Hosp Univ Penn, Dept Urol, Philadelphia, PA 19104 USA
[9] Hosp Univ Penn, Dept Radiat Oncol, Philadelphia, PA 19104 USA
关键词
radical prostatectomy (RIP); conventional dose radiation therapy (RT); prostate carcinoma; prostate specific antigen (PSA); survival;
D O I
10.1002/cncr.10657
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND. To the authors' knowledge, consensus is lacking regarding the relative long-term efficacy of radical prostatectomy (RP) versus conventional-dose external beam radiation therapy (RT) in the treatment of patients with clinically localized prostate carcinoma. METHODS. A retrospective cohort study of 2635 men treated with RP (n = 2254) or conventional-dose RT (n = 381) between 1988-2000 was performed. The primary endpoint was prostate specific antigen (PSA) survival stratified by treatment received and high-risk, intermediate-risk, or low-risk group based on the serum PSA level, biopsy Gleason score, 1992 American joint Commission on Cancer clinical tumor category, and percent positive prostate biopsies. RESULTS. Estimates of 8-year PSA survival (95% confidence interval [95% CI]) for low-risk patients (T1c,T2a, a PSA level less than or equal to 10 ng/mL, and a Gleason score less than or equal to 6) were 88% (95% CI, 85, 90) versus 78% (95% CI, 72, 83) for RP versus patients treated with RT, respectively. Eight-year estimates of PSA survival also favored RP for intermediate-risk patients (T2b or Gleason score 7 or a PSA level > 10 and less than or equal to 20 ng/mL) with < 34% positive prostate biopsies, being 79% (95% CI, 73, 85) versus 65% (95% CI, 58, 72), respectively. Estimates of PSA survival in high-risk (T2c or PSA level > 20 ng/mL or Gleason score 8) and intermediate-risk patients with at least 34% positive prostate biopsies initially favored RT, but were not significantly different after 8 years. CONCLUSIONS. intermediate-risk and low-risk patients with a low biopsy tumor volume who were treated with RP appeared to fare significantly better compared with patients who were treated using conventional-dose RT. Intermediate-risk and high-risk patients with a high biopsy tumor volume who were treated with RP or RT had long-term estimates of PSA survival that were not found to be significantly different. (C) 2002 American Cancer Society.
引用
收藏
页码:281 / 286
页数:6
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