A Comparison of Cause-specific Mortality among Patients with Low or Intermediate-risk Prostate Cancer Treated with Brachytherapy, External Beam Radiotherapy or Radical Prostatectomy

2009 
Purpose/Objective(s): Biochemically defined outcomes suggest equivalent efficacy among brachytherapy (PI), external beam radiotherapy (RT), and radical prostatectomy (RP) in patients with low or intermediate-risk prostate cancer (CaP). Similar data on prostate cancer-specific mortality (PCSM) are lacking. Materials/Methods: The records of 4222 consecutive patients with low or intermediate-risk disease treated between 9/96-9/05 were reviewed. Factors thought to influence mortality and PCSM were reviewed, including: age, Charlson score, initial PSA (iPSA), androgen deprivation (AD) duration, pack-years of smoking, income, body mass index (BMI), presence of coronary artery disease (CAD), presence of hypertension (HTN), alcohol use, race, biopsy Gleason score (bGS), and clinical stage. Univariate and multivariable analyses were done using competing risk methodology for Cox proportional hazards regression analysis. Results: Fifty-two percent of patients were treated with RP, 30% with PI, and 18% with RT. The median follow up for all patients was 48 months (range: 0-126). More than 50% of patients were treated after 2001. At the time of analysis, 264 patients (6.3%) had died- 23 from CaP, 92 from CAD, 94 from other cancers, and 55 from other causes. The results of the PCSMmultivariable analysis reveal that RT is associated with worse outcome relative to PI and RP (p\0.0001). Conclusions: Low and intermediate risk CaP patients treated with RT had a higher risk of death due to CaP than patients treated with RP or PI after adjusting for factors that influence overall and PCSM.
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