Retrospective comparison of external beam radiotherapy and radical prostatectomy in high-risk, clinically localized prostate cancer.
OBJECTIVE
Because of the lack of conclusive and well-conducted randomized studies, the optimal therapy for prostate tumors remains controversial. The aim of this study was to retrospectively compare the results of radical surgery vs. a conservative approach such as external beam radiotherapy (EBRT) plus androgen deprivation therapy using an intent-to-treat analysis on two pretreatment defined, concurrently treated, high-risk patient populations.


METHODS
Between January 2003 and December 2007, 162 patients with high-risk prostate cancer underwent an EBRT plus androgen deprivation therapy program at the RT department of our institute. In the same period, 122 patients with the same high-risk disease underwent radical prostatectomy (RP) at the urologic department of our institute. Patients with adverse pathologic factors also underwent adjuvant EBRT with or without androgen deprivation therapy. The primary endpoint was freedom from biochemical failure.


RESULTS
The two groups of high-risk patients were homogeneous in terms of freedom from biochemical failure on the basis of the clinical T stage, biopsy Gleason score, and initial prostate-specific antigen level. The median follow-up was 38.6 and 33.8 months in the EBRT and RP groups, respectively. The actuarial analysis of the freedom from biochemical failure showed a 3-year rate of 86.8% and 69.8% in the EBRT and RP group, respectively (p = .001). Multivariate analysis of the whole group revealed the initial prostate-specific antigen level and treatment type (EBRT vs. RP) as significant covariates.


CONCLUSIONS
This retrospective intention-to-treat analysis showed a significantly better outcome after EBRT than after RP in patients with high-risk prostate cancer, although a well-conducted randomized comparison would be the best procedure to confirm these results.
Arcangeli
Giorgio
G
Department of Radiotherapy, Regina Elena National Cancer Institute, Rome, Italy. arcangeli@ifo.it
Strigari
Lidia
L
Arcangeli
Stefano
S
Petrongari
Maria Grazia
MG
Saracino
Biancamaria
B
Gomellini
Sara
S
Papalia
Rocco
R
Simone
Giuseppe
G
De Carli
Piero
P
Gallucci
Michele
M
D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012384:Rome; D016896:Treatment Outcome
D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen