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OUTCOME OF PRIMARY TX: Comparison Of Outcomes Of Three Modalities Of
Primary Treatment: (January
2006)
“Monotherapy for Stage T1
- T2 Prostate Cancer: Radical Prostatectomy, External Beam Radiotherapy,
or Permanent Seed Implantation” - Radiotherapy and Oncology 71 (2004)
Carefully done
“apples-to-apples” comparisons of outcomes for different types of
treatment of clinical localized prostate cancer are welcomely informative.
This article by Potter, Klein, Kattan, Kupelian et al. analyzes a study
cohort of 1819 men with clinically localized disease - 1178 from the
Cleveland Clinic Foundation (746-RP, 340-RT, 91-PPB) and 641-PPB
(permanent prostate brachytherapy) treated at Memorial Sloan Kettering
between 1992 and 1998. The median follow-up time was 58 months. This data
builds on the Cleveland Clinic analysis reported in JCO, August 2002,
comparing outcomes of RP and EBRT for cT1 and cT2 cancer. “The [current]
study excluded all patients who received any neoadjuvant or adjuvant
therapy”. Of surgical cases 75% had pelvic node dissection [not further
described] and 1.5% were positive, compared nodal biopsies in 3% of EBRT
patients where none were positive.
The median dose of EBRT
was 74 Gy (range 70.0-83.0 Gy), 94% delivered with 3DCRT technique. I-125
implants were dosed at 144 Gy and Pd-103 at 136 Gy, a comparable dose.
The final pathologic status of the 746 RP surgery cases showed organ
confined disease in 59%; specimen confined disease in 16%; and seminal
vesicle invasion, 8%.
The PSA failure point for
RP patients was set at two consecutive values greater than 0.2ng/mL, with
time-to-failure recorded as the first elevation. For radiation patients
the ASTRO definition was used: “three consecutive rising PSA levels from
nadir with a 2-year minimum follow-up”, and failure was assigned at midway
between the nadir and the first elevation above the nadir. The mean
initial PSA was 9 ng/mL (RP-8.8; EBRT-9.5; PPB-9.15).
The high credibility of
this data lies is the well-matched clinical characteristics of the men in
the three cohorts. Clinical stage comparison: Stage T1 - 55%, 53%, 53% for
RP, PPB, EBRT ; T2a - 41%, 41%, and 40%; and T2b - 4%, 6%, and 7%,
respectively. Gleason score comparison: Gleason score 2 to 6 - 77%, 77%,
71%; Gleason score 7 - 20%, 20% and 25%; and 8%, 2%, and 4% for Gleason
score 8 and 9, respectively.
Results: The 7-year
freedom from biochemical relapse rates for RP vs PPB vs EBRT were 79, 74,
and 77% respectively, with no significant difference. The disease specific
survivals were: 99%, 100% and 98%, again respectively.
Bottom Line:
Paraphrasing Dr. Peter Carroll’s remark at the 2005 8th Annual
Brachytherapy Conference, This battle is over.
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