title: Five year biochemical recurrence free survival for intermediate risk prostate cancer after radical prostatectomy, external beam radiation therapy or permanent seed implantation.
abstract: OBJECTIVE
  To compare biochemical recurrence-free survival (bRFS) for patients with intermediate-risk prostate cancer treated by retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), external beam radiation therapy (RT), or permanent seed implantation (PI).
  
  
  METHODS
  Patients treated for intermediate-risk prostate cancer per National Comprehensive Cancer Network guidelines from 1996 to 2005 were studied. Variables potentially affecting bRFS were examined using univariate and multivariate Cox regression analysis. Five-year bRFS rates were calculated by actuarial methods; bRFS was calculated using Kaplan-Meier analysis. Nadir +2 definition of biochemical failure was used for RT and PI patients; a PSA ≥ 0.4 ng/mL was used for radical prostatectomy (RP) patients. Time to initiation of salvage therapy was compared for each treatment group using the Kruskal-Wallis test.
  
  
  RESULTS
  Nine-hundred seventy-nine patients were analyzed with a median follow-up of 65 months. Five years bRFS rate was 82.8% for all patients (89.5% PI, 85.7% RT, 79.9% RRP, and 60.2% LRP). Patients treated by LRP had significantly worse bRFS than RT (P < .0001), PI (P < .0001), or RRP patients (P = .0038). Treatment modality (P < .0001) and average number of PSA tests per year (P < .0001) were the only independent predictors of bRFS on multivariate analysis. Median time to initiation of salvage therapy from time of treatment was 28.6 months for all patients (26.1 RP, 21.0 LRP, 47.4 PI, 47.8 RT; P < .0001).
  
  
  CONCLUSIONS
  Patients with intermediate-risk prostate cancer choosing PI, RT, or RRP appear to have improved 5-year bRFS and delayed salvage therapy compared with LRP.
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA. vassila@ccf.org
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Vassil
authors.forename: Erin S
authors.initials: ES
authors.lastname: Murphy
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Angermeier
authors.forename: Andrew
authors.initials: A
authors.lastname: Altman
authors.forename: Nabil
authors.initials: N
authors.lastname: Chehade
authors.forename: James
authors.initials: J
authors.lastname: Ulchaker
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen