An interinstitutional and interspecialty comparison of treatment outcome data for patients with prostate carcinoma based on predefined prognostic categories and minimum follow‐up

Abstract

BACKGROUND The optimal management of patients with clinically localized prostate carcinoma remains undefined due in part to the absence of well‐designed, prospective, randomized trials. The current study was conducted to compare and contrast outcomes with different forms of therapy for patients with prostate carcinoma who were treated at several institutions using predefined prognostic categories. METHODS A retrospective study of 6877 men with prostate carcinoma who were treated between 1989 and 1998 at 7 different institutions with 6 different types of therapy was conducted. Five‐year actuarial rates of prostate specific antigen (PSA) failure were calculated based on predefined prognostic categories, which included combinations of pretreatment PSA level, tumor stage, and Gleason score. In addition, outcome was calculated using consistent biochemical failure definitions and a minimum, median length of follow‐up. RESULTS Substantial differences in outcome were observed for the same type of treatment and at the same institution, depending on the number of prognostic variables used to define treatment groups. However, estimates of 5‐year PSA outcomes after all forms of therapy for low‐risk and intermediate‐risk patient groups were remarkably similar (regardless of the type of treatment) when all three pretreatment variables were used to define prognostic categories. For patients in high‐risk groups, the 5‐year PSA outcomes were suboptimal, regardless of the treatment technique used. CONCLUSIONS The current data suggest that interinstitutional and interspecialty comparisons of treatment outcome for patients with prostate carcinoma are possible but that results must be based on all major prognostic variables to be meaningful. Analyzed in this fashion, 5‐year PSA results were similar for patients in low‐risk and intermediate‐risk groups, regardless of the form of therapy. Findings from prospective, randomized trials using survival (cause specific and overall) as the end point for judging treatment efficacy and longer follow‐up will be needed to validate these findings and to identify the most appropriate management option for patients with all stages of disease. Cancer 2002;95:2126–35. © 2002 American Cancer Society. DOI 10.1002/cncr.10919

Iodine seed prostate brachytherapy: an alternative first-line choice for early prostate cancer

“…A recent prospective study of over 6500 patients treated with either brachytherapy, radiotherapy or radical prostatectomy, who were stratified according to a PSA and Gleason score, would appear to show that there is no significant difference between any of the primary treatment options. 34 The only consistent finding was that conformal beam radiotherapy fared better than conventional external beam radiotherapy but no individual treatment had overall superiority. A further retrospective comparison of 1305 patients treated for stage T1-2 prostate cancer by either radical prostatectomy or brachytherapy failed to demonstrate any clear superiority of one treatment over the other.…”

Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy

“…Potters and colleagues found that the 7-year bRFS hazard ratio for radiotherapy (all treated with ≥70 Gy) compared to surgery was 1.18 (0.86-1.62), 22 while Martinez and colleagues found no difference in the 7-year bRFS odds ratio: 0.98 (0.55-1.74) with radiotherapy doses between 59-70 Gy. 23 Vicini and colleagues found no statistically significant differences in bRFS for any subgroup formed and varying approaches to radiotherapy delivery across seven institutions; 24 and Kupelian and colleagues computed a hazard ratio of 1.01 (p = 0.96) comparing radiotherapy (68-78 Gy) to surgery for difference in bRFS after control for disease severity and other key confounding variables. 25 D'Amico and colleagues found no difference in 8-year bRFS for intermediate-risk patients with high volume tumours and high-risk patients, however they did observe higher 8-year bRFS for low-risk patients or intermediate-risk patients with low volume tumours treated surgically compared to the radiotherapy group whose median dose was 66 Gy.…”

State-of-the-art: prostate LDR brachytherapy

“…LDR brachytherapy S Voulgaris et al prostate cancer. 5,6,21 Contemporary patients tend to place equal emphasis on the expected prostate cancer survival outcomes and post-treatment quality of life associated with each treatment modality. 33 Therefore issues concerning quality of life after treatment for localized prostate cancer are becoming increasingly important.…”

“…Available evidence from non-randomized cohort studies suggest that all modalities have comparable results, in terms of cancer control and survival. [4][5][6] As a result, patients with localized prostate cancer are often faced with the dilemma of choosing a treatment based on the side-effect profile and the potential impact on the quality of life.…”