title: Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer.
abstract: BACKGROUND
  The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT).
  
  
  METHODS
  In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification ≥ T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model.
  
  
  RESULTS
  The 10-year cancer-specific survival rate was 92%, 92%, and 88% after RRP, EBRT plus ADT, and EBRT alone, respectively (P = .06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.51-1.18; P = .23) or prostate cancer death (HR, 1.14; 95% CI, 0.68-1.91; P = .61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95% CI, 1.25-2.05; P = .0002).
  
  
  CONCLUSIONS
  RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients.
authors.affiliation: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA. sboorjian@gmail.com
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Rosalia
authors.initials: R
authors.lastname: Viterbo
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Rangel
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bergstralh
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
authors.forename: Mark K
authors.initials: MK
authors.lastname: Buyyounouski
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D000728:Androgens; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D000728:Androgens