EQUIVALENT 5-YEAR BNED IN SELECT PROSTATE-CANCER PATIENTS MANAGED WITH SURGERY OR RADIATION-THERAPY DESPITE EXCLUSION OF THE SEMINAL-VESICLES FROM THE CTV

Purpose: Prostate Specific Antigen (PSA) failure free survival was det ermined for select prostate cancer patients managed definitively with external beam radiation therapy to the prostate only or radical retrop ubic prostatectomy. Methods and Materials: A logistic regression multi variable analysis evaluating the variables of PSA, biopsy Gleason scor e, and clinical stage was used to evaluate the endpoint of pathologic seminal vesicle invasion (SVI) in 749 consecutive prostate cancer pati ents managed with a radical retropubic prostatectomy. In a subgroup of 332 surgically and 197 radiation managed patients who did not have th e clinical predictors of SVI, PSA failure free survival (bNED) was det ermined. Comparisons were made using the log rank test between surgica lly and radiation managed patients in this subgroup. In this subgroup, radiation managed patients were treated to a median dose of 66 Gy (66 -70 Gy) to the prostate only. Results: The pretreatment PSA (>10 ng/ml ), biopsy Gleason score (greater than or equal to 7), and clinical sta ge (T2b, 2c, or 3) were found to be significant independent predictors (p < 0.001) of SVI. Only 2% of patients without any of these factors had SVI and 17% had extracapsular extension (15% microscopic; 2% macro scopic). In this subgroup the 5-year bNED rates were equivalent [84 vs . 89% (p = 0.67)] for surgically and radiation managed patients, respe ctively.Conclusions: Conventional dose external beam radiation therapy directed at the prostate alone resulted in 5-year bNED rates equivale nt to surgery on retrospective comparison in patients with clinical st age T1,2a, PSA less than or equal to 10 ng/ml, and biopsy Gleason less than or equal to 6 prostate cancer. (C) 1997 Elsevier Science Inc.