Knife or needles? A cohort analysis of outcomes after radical prostatectomy or brachytherapy for men with low- or intermediate-risk adenocarcinoma of the prostate.
OBJECTIVE
The purpose of this study was to evaluate long-term outcomes for men with early stage prostate cancer treated with radical prostatectomy (RP) or brachytherapy (BT) at a single tertiary care center.


METHODS
We retrospectively analyzed data from 371 men with clinical T1a-T2c disease with prostate-specific antigen level <20 ng/mL and Gleason score (GS) 6-7 who were treated with RP (n=279) or BT (n=92) at MD Anderson Cancer Center in 2000-2001. Biochemical recurrence-free survival (BRFS) and prostate cancer-specific survival rates were compared by treatment modality.


RESULTS
The median followup time was 7.2 and 7.6 years for patients treated with RP and BT, respectively. Disease was upgraded from GS 6 to 7 after central review of the biopsy specimen for 36 men treated with RP (12.9%) and 15 men treated with BT (16.3%). After RP, GS was upgraded in 121 men (43.4%) between the centrally reviewed biopsy and the RP specimen. After RP, 5-year BRFS rates were 96.1% and 90.6% for low- and intermediate-risk disease, respectively (p=0.003). After BT, 5-year BRFS rates were 92.5% and 95.8% for low- and intermediate-risk disease, respectively (p=0.017). After RP or BT, 5-year BRFS rates were not significantly different with GS upgraded. Five-year prostate cancer-specific survival rates for patients with upgraded GS were 100% for both RP and BT.


CONCLUSIONS
Excellent disease control outcomes can be achieved after either RP or BT as monotherapy for men with early stage prostate cancer. Upgrading of GS from 6 to 7, either (3+4) or (4+3), did not predict for worse outcomes.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Christine M
CM
Fisher
Patricia
P
Troncoso
David A
DA
Swanson
Mark F
MF
Munsell
Deborah A
DA
Kuban
Andrew K
AK
Lee
Shih-Fan
SF
Yeh
Steven J
SJ
Frank
D000230:Adenocarcinoma / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D001918:Brachytherapy / Q000401:mortality* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011468:Prostatectomy / Q000401:mortality* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome