title: Radical prostatectomy versus external-beam radiotherapy for localized prostate cancer: long-term effect on biochemical control-in search of the optimal treatment.
abstract: BACKGROUND
  The optimal management of patients with clinically localized prostate carcinoma remains undefined due in part to the absence of well-designed, randomized trials.
  
  
  METHODS
  This retrospective study comprised 505 patients diagnosed with low- or intermediate- risk prostate cancer in 1998-2005 and treated at Hospital Gregorio Marañón (Spain) with radical prostatectomy (RP) or external-beam radiotherapy (EBRT). No adjuvant therapy was administered. Biochemical relapse was defined as a prostate-specific antigen (PSA) level ≥0.4 ng/ml for RP cases and nadir + 2 for EBRT cases. RP was performed in 271 patients (53.6%) and EBRT in 234 patients (46.4%). The median follow-up was 60 months. The analysis end point was to compare the biochemical recurrence-free survival (bRFS) between the two groups.
  
  
  RESULTS
  The 5-year bRFS rates for RP and EBRT were 79 ± 2% and 86 ± 2%, respectively (P = 0.48). Multivariate analysis indicated that initial PSA (P = 0.00), perineural invasion in the biopsy specimen (P = 0.00), Gleason score (P = 0.04), EBRT dose (P = 0.02), and positive margins (P = 0.00) were independent predictors of relapse. A decision tree model was constructed with these variables. In the EBRT cohort, a nadir PSA of <0.3 ng/ml was associated with the best 5-year bRFS (96.6 vs. 56.5% if nadir PSA > 1.3 ng/ml). Late biochemical failure (>5 years) was more frequent in the RT group and with low-dose EBRT (≤72 Gy).
  
  
  CONCLUSIONS
  The biochemical failure rates were similar between PR and EBRT in low- and intermediate-risk subgroups. Outcome was determined by classic pre-treatment features, perineural invasion, low-dose EBRT (≤72 Gy), and nadir PSA value in the RT cohort.
authors: Radiation Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. cgss@saludalia.com
authors: Carmen
authors: C
authors: González-San Segundo
authors: Felipe
authors: F
authors: Herranz-Amo
authors: Ana
authors: A
authors: Alvarez-González
authors: Pedro
authors: P
authors: Cuesta-Álvaro
authors: Marina
authors: M
authors: Gómez-Espi
authors: Eva
authors: E
authors: Paños-Fagundo
authors: Juan A
authors: JA
authors: Santos-Miranda
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013995:Time
chemical_list: D017430:Prostate-Specific Antigen