BIOCHEMICAL OUTCOME AFTER RADICAL PROSTATECTOMY, EXTERNAL-BEAM RADIATION-THERAPY, OR INTERSTITIAL RADIATION-THERAPY FOR CLINICALLY LOCALIZED PROSTATE-CANCER

Context.-Interstitial radiation (implant) therapy is used to treat cli nically localized adenocarcinoma of the prostate, but how it compares with other treatments is not known. Objective.-To estimate control of prostate-specific antigen (PSA) after radical prostatectomy (RP), exte rnal beam radiation (RT), or implant with or without neoadjuvant andro gen deprivation therapy in patients with clinically localized prostate cancer. Design.-Retrospective cohort study of outcome data compared u sing Cox regression multivariable analyses. Setting and Patients.-A to tal of 1872 men treated between January 1989 and October 1997 with an RP (n = 888) or implant with or without neoadjuvant androgen deprivati on therapy (n = 218) at the Hospital of the University of Pennsylvania , Philadelphia, or RT (n = 766) at the Joint Center for Radiation Ther apy, Boston, Mass, were enrolled. Main Outcome Measure.-Actuarial free dom from PSA failure (defined as PSA outcome), Results.-The relative r isk (RR) of PSA failure in low-risk patients (stage Tie, T2a and PSA l evel less than or equal to 10 ng/mL and Gleason score less than or equ al to 6) treated using RT, implant plus androgen deprivation therapy, or implant therapy was 1.1 (95% confidence interval [CI], 0.5-2.7), 0. 5 (95% CI, 0.1-1.9), and 1.1 (95% CI, 0.3-3.6), respectively, compared with those patients treated with RP. The RRs of PSA failure in the in termediate-risk patients (stage T2b or Gleason score of 7 or PSA level >10 and less than or equal to 20 ng/mL) and high-risk patients (stage T2c or PSA level >20 ng/mL or Gleason score greater than or equal to 8) treated with implant compared with RP were 3.1 (95% CI, 1.5-6.1) an d 3.0 (95% CI, 1.8-5.0), respectively, The addition of androgen depriv ation to implant therapy did not improve PSA outcome in high-risk pati ents but resulted in a PSA outcome that was not statistically differen t compared with the results obtained using RP or RT in intermediate-ri sk patients. These results were unchanged when patients were stratifie d using the traditional rankings of biopsy Gleason scores of 2 through 4 vs 5 through 6 vs 7 vs 8 through 10, Conclusions.-Low-risk patients had estimates of 5-year PSA outcome after treatment with RP, RT, or i mplant with or without neoadjuvant androgen deprivation that were not statistically different, whereas intermediate- and high-risk patients treated with RP or RT did better then those treated by implant, Prospe ctive randomized trials are needed to verify these findings.