title: What is the optimal management of Gleason score 7 prostate cancer at biopsy? A comparison of disease control for prostatectomy versus radiotherapy.
abstract: OBJECTIVE
  To compare outcomes between radical prostatectomy (RP) or radiotherapy (RT) approaches for Gleason 7 (GS7) prostate cancer.
  
  
  METHODS
  Patients were retrospectively identified for inclusion by clinically localized disease, GS7, prostate-specific antigen (PSA) < 30 ng/mL at diagnosis, and follow-up with PSA at > 12 months. Comparison of demographic, tumor, staging, and outcome variables was performed. Disease recurrence was defined as per contemporary society guidelines. The Kaplan-Meier method was used for disease control estimates.
  
  
  RESULTS
  Between 2003 and 2010, a total of 253 patients were diagnosed with GS7 prostate cancer, of whom 207 were eligible for the current analysis (120 RP, 87 RT). Excepting older age for RT patients (median 73 vs. 62 years), the groups were well balanced. For RP patients, 82 patients (60%) had at least 1 high-risk feature, 4 (5%) of whom received adjuvant RT. For RT patients, 71 patients (82%) received hormone therapy (median duration 6 months). At a median follow-up of 62.2 months (range 13.1-136.6 months, with no difference between treatment groups), 64 patients had PSA relapse (51 RP, 13 RT), and 15 had died (5 of or with disease). PSA relapse-free survival was inferior for RP versus RT (P < .0001), with 5-year rates of 55.4% versus 82.6%, respectively.
  
  
  CONCLUSIONS
  For GS7 prostate cancer patients, RT is associated with superior disease-free survival at 5 years compared to RP alone, without difference in disease-specific survival. Whether this difference remains in the setting of appropriately used adjuvant RT after RP, and the effect of possible delay in testosterone recovery for older RT patients remain to be determined.
authors.affiliation: Department of Radiation Oncology, University of Iowa, Carver School of Medicine, Iowa City, IA; Bismarck Cancer Center, Bismarck, ND. Electronic address: john.m.watkins.md@hotmail.com.
authors.forename: John M
authors.initials: JM
authors.lastname: Watkins
authors.affiliation: Bismarck Cancer Center, Bismarck, ND; Department of Pediatrics, University of Iowa, Carver School of Medicine, Iowa City, IA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Watkins
authors.affiliation: Bismarck Cancer Center, Bismarck, ND.
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Dufan
authors.affiliation: Department of Urology, Sanford Bismarck Medical Center, Bismarck, ND.
authors.forename: Nadim
authors.initials: N
authors.lastname: Koleilat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: Hormone therapy; Prostate neoplasms; Radical prostatectomy; Radiotherapy; Survival analysis