title: Pelvic Radiotherapy versus Radical Prostatectomy with Limited Lymph Node Sampling for High-Grade Prostate Adenocarcinoma.
abstract: Purpose. To compare oncologic outcomes for patients with Gleason score (GS) ≥ 8 prostate adenocarcinoma treated with radical prostatectomy (RP) versus external beam radiotherapy combined with androgen deprivation (RT + ADT). Methods. Between 2001 and 2014, 121 patients with GS ≥ 8 were treated at our institution via RT + ADT (n = 71) or RP (n = 50) with ≥ 1 year of biochemical follow-up. Endpoints included biochemical failure (BF), distant metastasis, and initiation of salvage ADT. Results. The RT + ADT group was older, had higher biopsy GS, and had greater risk of lymph node involvement. All other pretreatment characteristics were similar between groups. Mean number of lymph nodes (LNs) sampled for patients undergoing RP was 8.2 (±6.18). Mean biochemical follow-up for all patients was 61 months. Five-year estimates of BF for the RT + ADT and RP groups were 7.2% versus 42.3%, (p < 0.001). The RT + ADT group also had lower rates of distant metastasis (2% versus 7.8%) and salvage ADT (8% versus 33.8%). Conclusion. In this analysis, RT + ADT was associated with improved biochemical and metastatic control when compared to RP with limited LN sampling. How RT + ADT compares with more aggressive lymphadenectomy, as is currently our institutional standard, remains an important unanswered question.
authors.affiliation: University of Alabama School of Medicine, Birmingham, AL 35233, USA.
authors.forename: Christopher B
authors.identifier: 0000-0002-6274-0579
authors.initials: CB
authors.lastname: Baker
authors.affiliation: Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: McDonald
authors.affiliation: Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: Eddy S
authors.initials: ES
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: Rojymon
authors.initials: R
authors.lastname: Jacob
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35249, USA; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Nix
authors.affiliation: Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Fiveash