Comparing Treatment Options for High-Risk Patient with Prostate Cancer:Radiotherapy vs. Radical Prostatectomy

Sophie G Fletcher, Stacey E Mills*, Mark E Smolkin*, Dan Theodorescu
University of Virginia, Charlottesville, VA

Introduction: We present a cohort-matched, single institution study comparing radiotherapy to surgery for locally advanced prostate cancer (CaP).
Methods: From 3-97 to 12-00, 409 men with PSA ≥10 or Gleason score ≥7 or stage ≥T2b CaP were treated with Pd Brachytherapy monotherapy (BTM), BT with XRT (BTC) or radical prostatectomy (RP). Study endpoint was biochemical relapse-free survival (BFS) using PSA>0.2ng/ml or ASTRO criteria. All pathology was reviewed by one genitourinary pathologist. Kaplan-Meier survival functions and multivariate modeling adjusting for baseline PSA and GS examined the relationship between treatment and BFS. 104 matched pairs: RP vs. BTC further examined this relationship, minimizing differences between groups.
Results: Tumor characteristics are demonstrated in table below. Estimated BFS rates at 4 years revealed treatment group differences using PSA >0.20 (BTM 25%, RP 53%, BTC 72%; p<0.001), but not ASTRO criteria. Using PSA>0.20, multivariate Cox modeling yielded hazard ratios for failure: BTM 2.92 and BTC 0.56 relative to RP (p<0.001, p=0.010). Cohort matched analysis showed BFS rates: RP 55% vs. BTC 73% (p=0.010).
Conclusions: We found BT + XRT superior to either RP and BTM in the treatment of high-risk CaP. Without randomized trials, our study has important implications on recommendations for high risk patients.

Tumor Characteristics as a Function of Treatment Modality

Parameter	RP (73)	BTM (72)	BTC (127)
PSA (median)	10	10	10
% Pts GS>7	73	43	87
% Pts Stage>2b	18	19	33

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