Radical prostatectomy vs. intensity-modulated radiation therapy in the management of localized prostate adenocarcinoma

Background and purpose: To determine whether radical prostatectomy (RP) or intensity-modulated radiation therapy (IMRT) to >= 72 Gy, plus hormonal therapy if indicated, results in improved biochemical disease-free survival (BDFS) in localized prostate adenocarcinoma. Materials and methods: Between 1997 and 2005, a consecutive sample of 556 patients who underwent RP (n = 204) or IMRT (n = 352) at two referral centers was analyzed. The patients were stratified into prognostic groups based on clinical stage, Gleason score, and pretreatment prostate-specific antigen (PSA). The outcome measure was BDFS. Results: IMRT patients had more advanced disease at baseline (p < .001). There was no difference in five-year BDFS rates between RP and IMRT in the favorable (92.8% vs. 85.3%, p = .20) or intermediate prognosis (86.7% vs. 82.2%, p = .46) subsets. A difference favoring IMRT plus hormonal therapy was seen in the poor prognosis (38.4% vs. 62.2%, p < .001) subset. Within the entire cohort, after adjustment for confounding variables, Gleason score (p <.001) and clinical stage (p <.001) predicted BDFS, but treatment modality (p = .06) did not. Within the poor prognosis subset, treatment modality (p = .006) predicted BDFS. Conclusions: BDFS is similar between RP and IMRT for patients with a favorable or intermediate prognosis. Patients with a poor prognosis display higher BDFS when treated with IMRT to >= 72 Gy plus hormonal therapy. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 93 (2009) 185-191