Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: A comparison of clinical cohorts adjusted for case mix Journal Article

   

Authors:	Zelefsky, M. J.; Eastham, J. A.; Cronin, A. M.; Fuks, Z.; Zhang, Z.; Yamada, Y.; Vickers, A.; Scardino, P. T.
Article Title:	Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: A comparison of clinical cohorts adjusted for case mix
Abstract:	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 with RP or EBRT at a single specialized cancer center. Patients and Methods Patients with clinical stages T1c-T3b prostate cancer were treated with intensity-modulated EBRT (>= 81 Gy) or RP. Both cohorts included patients treated with salvage radiotherapy or androgen-deprivation therapy for biochemical failure. Salvage therapy for patients with RP was delivered a median of 13 months after biochemical failure compared with 69 months for EBRT patients. DM was compared controlling for patient age, clinical stage, serum prostate-specific antigen level, biopsy Gleason score, and year of treatment. Results The 8-year probability of freedom from metastatic progression was 97% for RP patients and 93% for EBRT patients. After adjustment for case mix, surgery was associated with a reduced risk of metastasis (hazard ratio, 0.35; 95% CI, 0.19 to 0.65; P < .001). Results were similar for prostate cancer-specific mortality (hazard ratio, 0.32; 95% CI, 0.13 to 0.80; P = .015). Rates of metastatic progression were similar for favorable-risk disease (1.9% difference in 8-year metastasis-free survival), somewhat reduced for intermediate-risk disease (3.3%), and more substantially reduced in unfavorable-risk disease (7.8% in 8-year metastatic progression). Conclusion Metastatic progression is infrequent in men with low-risk prostate cancer treated with either RP or EBRT. RP patients with higher-risk disease treated had a lower risk of metastatic progression and prostate cancer-specific death than EBRT patients. These results may be confounded by differences in the use and timing of salvage therapy.
Keywords:	high-risk; randomized controlled-trial; radiation-therapy; phase-iii trial; adjuvant; dose-response; locally; advanced-carcinoma; androgen suppression; definitive radiotherapy; intermediate-risk
Journal Title:	Journal of Clinical Oncology
Volume:	28
Issue:	9
ISSN:	0732-183X
Publisher:	American Society of Clinical Oncology
Date Published:	2010-03-01
Start Page:	1508
End Page:	1513
Language:	English
ACCESSION:	ISI:000275824600012
DOI:	10.1200/jco.2009.22.2265
PROVIDER:	wos
PUBMED:	20159826
PMCID:	PMC3731893
Notes:	--- - Article - "Source: Wos"

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