High-grade carcinoma of the prostate: A comparison of current local therapies

Objectives. To determine the impact of either single or combined local ther apeutic modalities for poorly differentiated (Gleason score 8 to 10) prosta te cancer. Methods. Between 1987 and 1996, 156 patients were diagnosed with biopsy pro ven, poorly differentiated (Gleason score 8 to 10), clinically localized pr ostate cancer. Of these patients, 87 were treated with radical prostatectom y alone, 19 with radiotherapy, and 24 with both prostatectomy and postopera tive radiotherapy. Results. The median follow-up time was 74.6 months. The 5-year biochemical progression-free survival (PFS) for patients with a Gleason score of 8 to 1 0 was 65%, 30%, and 20% for patients treated with surgery plus postoperativ e radiotherapy, radiotherapy alone, and surgery alone, respectively (P <0.0 001 between postoperative radiotherapy and all other groups, P = 0.6131 bet ween surgery and radiotherapy). The 5-year clinical PFS was 80%, 60%, and 3 5% for patients treated with surgery plus postoperative radiotherapy, radio therapy alone, and surgery alone (P <0.0001 between postoperative radiother apy and all others, P = 0.1975 between surgery and radiotherapy). The indep endent prognosticators for biochemical failure included serum prostate-spec ific antigen level greater than 20 ng/mL and seminal vesicle invasion; only seminal vesicle invasion was prognostic for clinical failure. Conclusions. Patients with high-grade prostate cancer (Gleason score 8 to 1 0) have uniformly poor, but apparently similar, biochemical and clinical PF S rates when treated by either prostatectomy or radiotherapy alone. The add ition of postoperative radiotherapy in the treatment of these patients may be associated with improved biochemical and clinical PFS compared with eith er modality alone. UROLOGY 57: 1121-1127, 2001. (C) 2001, Elsevier Science Inc.