Radical Prostatectomy versus External Beam Radiotherapy for cT1-4N0M0 Prostate Cancer: Comparison of Patient Outcomes Including Mortality.
BACKGROUND
Although radical prostatectomy (RP) and external beam radiotherapy (EBRT) have been considered as comparable treatments for localized prostate cancer (PC), it is controversial which treatment is better. The present study aimed to compare outcomes, including mortality, of RP and EBRT for localized PC.


METHODS
We retrospectively analyzed 891 patients with cT1-4N0M0 PC who underwent either RP (n = 569) or EBRT (n = 322) with curative intent at our single institution between 2005 and 2012. Of the EBRT patients, 302 (93.8%) underwent intensity-modulated radiotherapy. Primary endpoints were overall survival (OS) and cancer-specific survival (CSS). Related to these, other-cause mortality (OCM) was also calculated. Biochemical recurrence-free survival was assessed as a secondary endpoint. Cox proportional hazards model was used for multivariate analysis.


RESULTS
Median follow-up durations were 53 and 45 months, and median ages were 66 and 70 years (P <0.0001), in the RP and EBRT groups, respectively. As a whole, significantly better prognoses of the RP group than the EBRT group were observed for both OS and CSS, although OCM was significantly higher in the EBRT group. There was no death from PC in men with low and intermediate D'Amico risks, except one with intermediate-risk in the EBRT group. In high-risk patients, significantly more patients died from PC in the EBRT group than the RP group. Multivariate analysis demonstrated the RP group to be an independent prognostic factor for better CSS. On the other hand, the EBRT group had a significantly longer biochemical recurrence-free survival than the RP group.


CONCLUSIONS
Mortality outcomes of both RP and EBRT were generally favorable in low and intermediate risk patients. Improvement of CSS in high risk patients was seen in patients receiving RP over those receiving EBRT.
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Satoru
S
Taguchi
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hiroshi
H
Fukuhara
Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan.
Kenshiro
K
Shiraishi
Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan.
Keiichi
K
Nakagawa
Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Teppei
T
Morikawa
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Shigenori
S
Kakutani
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yuta
Y
Takeshima
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hideyo
H
Miyazaki
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Tetsuya
T
Fujimura
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Tohru
T
Nakagawa
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Haruki
H
Kume
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yukio
Y
Homma
D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D050397:Radiotherapy, Intensity-Modulated; D012669:Seminal Vesicles / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome