UROLOGICAL ONCOLOGY

Monotherapy for stage T1-T2 prostate cancer: radical prostatectomy, external beam radiotherapy, or permanent seed implantation
Potters L, Klein EA, Kattan MW, Reddy CA, Ciezki JP, Reuther AM, Kupelian PA
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center at Mercy Medical Center, Rockville Centre, NY, USA
Radiother Oncol. 2004; 71: 29-33

• Background and Purpose: To review the freedom from biochemical recurrence (FBR) rates after permanent prostate brachytherapy (PPB), external beam radiotherapy (RT) to a minimum 70Gy, or radical prostatectomy (RP) for clinically localized stage T1-T2 adenocarcinoma of the prostate.
• Patients and Methods: The study cohort consisted of 1819 consecutively treated clinical stage T1-T2 (AJCC 1997) localized prostate cancer patients between 1992 and 1998. All patients received monotherapy treatment without additional adjuvant therapy. The distribution by treatment modality was as follows: RT for 340, RP for 746, and PPB for 733 cases. The median follow-up time was 58 months for all cases (51 months for PPB cases, 56 months for RT cases, and 64 months for RP cases). Biochemical relapse was defined as to be detectable PSA levels in RP cases, and the ASTRO consensus panel definition for the RT and PPB cases.
• Results: The 7-year FBR rates for PPB vs. EBRT vs. RP were 74, 77, and 79%, respectively. Multivariate analysis identified iPSA (P < 0.001) and bGS (P < 0.001) as independent predictors of relapse. Treatment modality, age, clinical T-stage, and race were not independent predictors of failure.
• Conclusions: Pretreatment PSA levels, and biopsy Gleason score determined outcome in this study cohort. Biochemical failure rates in this study cohort are similar between PPB, RT, and RP as monotherapy for clinically localized prostate cancer.
  
  
• Editorial Comment
  Among several treatment options for localized prostate cancer radical prostatectomy is most often performed worldwide. The scientific basis for this , however, is swaying.
  This retrospective outcome analysis of data from 1819 patients treated with either radical prostatectomy (RP), external beam radiation therapy (ERBT), or permanent prostate brachytherapy (PPB) deserves interest as it focuses solely on the subgroup of patients without adjuvant or pretreatment hormone therapy, thus, a relatively favorable subgroup of prostate cancer patients.
  For all 1819 patients, the overall 7-year PSA progression rates were 76%. The 7-year PSA progression rates for RP, RT and PPB were 79%, 77% and 74% respectively. The multivariate analysis identified only pretreatment PSA and Gleason score as predictors for failure. With other words, first, no treatment fared significantly better than another. Second, there is still room for improvement especially in RT and PPB, as higher doses and better techniques are currently under evaluation here. I would predict that in 10 years from now RP would play an only minor role for the treatment of prostate cancer.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany