Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer

Stephen A. Boorjian, Robert Jeffrey Karnes, Rosalia Viterbo, Laureano J. Rangel, Eric J. Bergstralh, Eric M. Horwitz, Michael L. Blute, Mark K. Buyyounouski

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

BACKGROUND: The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT). METHODS: In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification ≥ T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model. RESULTS: The 10-year cancer-specific survival rate was 92%, 92%, and 88% after RRP, EBRT plus ADT, and EBRT alone, respectively (P =.06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.51-1.18; P =.23) or prostate cancer death (HR, 1.14; 95% CI, 0.68-1.91; P =.61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95% CI, 1.25-2.05; P =.0002). CONCLUSIONS: RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients.

Original languageEnglish (US)
Pages (from-to)2883-2891
Number of pages9
JournalCancer
Volume117
Issue number13
DOIs
StatePublished - Jul 1 2011

Fingerprint

Prostatectomy
Prostatic Neoplasms
Radiotherapy
Survival
Androgens
Therapeutics
Confidence Intervals
Neoplasms
Risk Adjustment
Mortality
Neoplasm Grading
Prostate-Specific Antigen
Survival Rate
Regression Analysis
Quality of Life
Biopsy

Keywords

  • androgen-deprivation therapy
  • prostate cancer
  • prostate-specific antigen
  • radiation therapy
  • radical prostatectomy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Boorjian, S. A., Karnes, R. J., Viterbo, R., Rangel, L. J., Bergstralh, E. J., Horwitz, E. M., ... Buyyounouski, M. K. (2011). Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. Cancer, 117(13), 2883-2891. https://doi.org/10.1002/cncr.25900

Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. / Boorjian, Stephen A.; Karnes, Robert Jeffrey; Viterbo, Rosalia; Rangel, Laureano J.; Bergstralh, Eric J.; Horwitz, Eric M.; Blute, Michael L.; Buyyounouski, Mark K.

In: Cancer, Vol. 117, No. 13, 01.07.2011, p. 2883-2891.

Research output: Contribution to journalArticle

Boorjian, SA, Karnes, RJ, Viterbo, R, Rangel, LJ, Bergstralh, EJ, Horwitz, EM, Blute, ML & Buyyounouski, MK 2011, 'Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer', Cancer, vol. 117, no. 13, pp. 2883-2891. https://doi.org/10.1002/cncr.25900
Boorjian, Stephen A. ; Karnes, Robert Jeffrey ; Viterbo, Rosalia ; Rangel, Laureano J. ; Bergstralh, Eric J. ; Horwitz, Eric M. ; Blute, Michael L. ; Buyyounouski, Mark K. / Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. In: Cancer. 2011 ; Vol. 117, No. 13. pp. 2883-2891.
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abstract = "BACKGROUND: The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT). METHODS: In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification ≥ T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model. RESULTS: The 10-year cancer-specific survival rate was 92{\%}, 92{\%}, and 88{\%} after RRP, EBRT plus ADT, and EBRT alone, respectively (P =.06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95{\%} confidence interval [CI], 0.51-1.18; P =.23) or prostate cancer death (HR, 1.14; 95{\%} CI, 0.68-1.91; P =.61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95{\%} CI, 1.25-2.05; P =.0002). CONCLUSIONS: RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients.",
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N2 - BACKGROUND: The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT). METHODS: In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification ≥ T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model. RESULTS: The 10-year cancer-specific survival rate was 92%, 92%, and 88% after RRP, EBRT plus ADT, and EBRT alone, respectively (P =.06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.51-1.18; P =.23) or prostate cancer death (HR, 1.14; 95% CI, 0.68-1.91; P =.61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95% CI, 1.25-2.05; P =.0002). CONCLUSIONS: RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients.

AB - BACKGROUND: The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT). METHODS: In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification ≥ T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model. RESULTS: The 10-year cancer-specific survival rate was 92%, 92%, and 88% after RRP, EBRT plus ADT, and EBRT alone, respectively (P =.06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.51-1.18; P =.23) or prostate cancer death (HR, 1.14; 95% CI, 0.68-1.91; P =.61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95% CI, 1.25-2.05; P =.0002). CONCLUSIONS: RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients.

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