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Radical Prostatectomy, External Beam Radiotherapy <72 Gy, External Beam Radiotherapy >= 72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer, Patrick A. Kupelian, MD, Louis Potters, MD, Deepak Khuntia, MD, Jay P. Ciezki, MD, Chandana A. Reddy, MS, Alwyn M. Reuther, MPH, Thomas P. Carlson, MD, and Eric A. Klein, MD. International Journal of Radiation Oncology Biology – Physics, 2004;58(1):25-33.
| Type of Study |
Compares outcomes of prostate cancer patients undergoing different treatments. It represents the largest published series (of a contemporaneously treated cohort of patients in the “PSA era”) comparing the most frequently used therapies for clinically localized prostate cancer. |
| Purpose |
To compare treatment cure rates between brachytherapy (permanent seed implants), surgery, external beam radiation and combination therapies. |
| Issues |
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How effective is brachytherapy? |
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How does brachytherapy compare to other prostate cancer treatments? |
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| Number of Patients |
2,991 |
| Type of Patients |
Stage T1-T2 prostate cancer (according to 1997 American Joint Commission criteria).
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| Length of Time
Patients Were Followed |
One year to 145 months. Median follow-up was 56 months. |
| Notes |
Biochemical relapse was defined as PSA levels >0.2 for radical prostatectomy cases and three consecutive rising PSA levels (American Society for Therapeutic Radiology and Oncology consensus definition) for all other cases. |
| Results and/or
Conclusions |
Brachytherapy, radical prostatectomy, high-dose external beam radiation therapy and combined therapies produced similar cure rates. The outcomes were significantly worse for low-dose external beam radiation therapy.
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“Patients with newly diagnosed localized prostate cancer face a bewildering number of choices among potentially curative therapies,” the report states. “In the past 15 years, radical prostatectomy (RP), various forms of external beam radiotherapy (EBRT), and brachytherapy have all been promoted as reasonable options… The goal of this report was to compile the available outcome data, so that patients can make informed decisions about the available treatment options.”
The study examined 2,991 patients with clinical Stage T1 and T2 prostate cancer treated at the Cleveland Clinic Foundation or Memorial Sloan-Kettering at Mercy Medical Center between 1990 and 1998. Of these, 35% of patients underwent surgery; 16% received low-dose EBRT; 10% received high-dose EBRT; 7% received combination therapy; and 32% experienced brachytherapy.
When examining results, except for low-dose EBRT, no difference was found in outcomes five and seven years following treatment, regardless of which treatment the patient received. After five years, biochemical relapse-free survival was as follows:
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83% Brachytherapy |
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81% Radical prostatectomy |
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81% High-dose EBRT |
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77% Combination therapy |
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51% Low-dose EBRT |
After seven years, biochemical relapse-free survival was as follows:
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81% High-dose EBRT |
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77% Combination therapy |
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76% Radical prostatectomy |
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75% Brachytherapy |
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48% Low-dose EBRT |
The results suggest that except for low-dose EBRT, biochemical failure at seven years is “determined more by the intrinsic tumor characteristics at the time of therapy rather than a specific treatment modality.”
Principal Investigator: Patrick A. Kupelian, M.D., M.D. Anderson Cancer Center, Orlando, Fla.
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