EQUIVALENT BIOCHEMICAL FAILURE-FREE SURVIVAL AFTER EXTERNAL-BEAM RADIATION-THERAPY OR RADICAL PROSTATECTOMY IN PATIENTS WITH A PRETREATMENTPROSTATE-SPECIFIC ANTIGEN OF GREATER-THAN-4-20 NG ML/

Purpose: Biochemical failure-free survival stratified by the pretreatm ent prostate-specific antigen (PSA) and biopsy Gleason score (bGl) is determined for prostate cancer patients managed definitively with exte rnal beam radiation therapy or radical retropubic prostatectomy. Metho ds and Materials: A Cox regression multivariable analysis evaluating t he variables of PSA, bGl, and clinical stage was used to evaluate the end point of time to PSA failure in 867 and 757 consecutive prostate c ancer patients managed definitively with external beam radiation thera py or radical retropubic prostatectomy, respectively. PSA failure-free survival was determined using Kaplan-Meier analysis. Comparisons were made using the log rank test. Results: The pretreatment PSA, bGl, and clinical stage (T3,4 vs. T1,T2) were found to be independent predicto rs of time to post-treatment PSA failure for both surgically and radia tion managed patients using Cox regression multivariable analysis. Pat ients with a pretreatment PSA of > 4 ng/ml and less than or equal to 2 0 ng/ml could be classified into risk groups for time to post-therapy PSA failure: low = PSA > 4-10 ng/ml and bGl less than or equal to 4; i ntermediate = PSA > 4-10 and bGl 5-7; or PSA > 10-20 ng/ml and bGl les s than or equal to 7; high = PSA > 4-20 ng/ml and bGl greater than or equal to 8. Two-year PSA failure-free survival for surgically managed and radiation-managed patients, respectively, were 98% vs. 92% (p = 0. 45), 77% vs. 81% (p = 0.86), and 51% vs. 53% (p = 0.48) for patients a t low, intermediate, and high risk for post-therapy PSA failure. Concl usions: There was no statistical difference in the 2-year PSA failure- free survival for potentially curable patients managed definitively wi th surgery or radiation therapy when a retrospective comparison strati fying for the pretreatment PSA and bGl was performed. (C) 1997 Elsevie r Science Inc.