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Comparison of outcomes for external
beam radiotherapy and radical prostatectomy. (October 2002)
Kupelian, in the August 15, 2002, issue
of the Journal of Clinical Oncology, presented a study comparing the
efficacy of radiotherapy versus radical prostatectomy involving 1682
Cleveland Clinic patients. 1054 patients had surgery and 628 had
radiotherapy with a median follow up of 51 months. The patients were
stratified by pretreatment PSA, stage, Gleason score and age. Numerically,
the RT group was slightly older and had slightly less favorable clinical
characteristics. An important finding was the clear superiority of RT > 72
Gy versus less. The 8-year bRFS rates of RP versus RT (all doses) were 72%
v.70%. RT when delivered at >72 Gy was slightly superior to RP (p=0.004).
For both treatment modalities the 5 year bRFS for T1-T2A was 90% and for
T2B-T2C 60%. ( An editorial reviews the study and refers to the utility
and validity of the Kattan nomogram referred to elsewhere in this
commentary)
Bottom Line: On an apples to apples comparison, RT = RP reminding us that
consideration of a patient's other clinical factors is key in selecting
treatment.
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