Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group

Peter Grimm, Ignace Billiet, David Bostwick, Adam P. Dicker, Steven Frank, Jos Immerzeel, Mira Keyes, Patrick Kupelian, W. Robert Lee, Stefan MacHtens, Jyoti Mayadev, Brian J. Moran, Gregory Merrick, Jeremy Millar, MacK Roach, Richard Stock, Katsuto Shinohara, Mark Scholz, Ed Weber, Anthony ZietmanMichael Zelefsky, Jason Wong, Stacy Wentworth, Robyn Vera, Stephen Langley

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289 Scopus citations

Abstract

A large number of studies have been conducted on the primary therapy of prostate cancer but very few randomized controlled trials have been conducted. The comparison of outcomes from individual studies involving surgery (radical prostatectomy or robotic radical prostatectomy), external beam radiation (EBRT) (conformal, intensity modulated radiotherapy, protons), brachytherapy, cryotherapy or high intensity focused ultrasound remains problematic due to the non-uniformity of reporting results and the use of varied disease outcome endpoints. Technical advances in these treatments have also made long-term comparisons difficult. The Prostate Cancer Results Study Group was formed to evaluate the comparative effectiveness of prostate cancer treatments. This international group conducted a comprehensive literature review to identify all studies involving treatment of localized prostate cancer published during 2000-2010. Over 18 000 papers were identified and a further selection was made based on the following key criteria: minimum/median follow-up of 5 years; stratification into low-, intermediate- and high-risk groups; clinical and pathological staging; accepted standard definitions for prostate-specific antigen failure; minimum patient number of 100 in each risk group (50 for high-risk group). A statistical analysis (standard deviational ellipse) of the study outcomes suggested that, in terms of biochemical-free progression, brachytherapy provides superior outcome in patients with low-risk disease. For intermediate-risk disease, the combination of EBRT and brachytherapy appears equivalent to brachytherapy alone. For high-risk patients, combination therapies involving EBRT and brachytherapy plus or minus androgen deprivation therapy appear superior to more localized treatments such as seed implant alone, surgery alone or EBRT. It is anticipated that the study will assist physicians and patients in selecting treatment for men with newly diagnosed prostate cancer.

Original languageEnglish (US)
Pages (from-to)22-29
Number of pages8
JournalBJU International
Volume109
Issue numberSUPPL. 1
DOIs
StatePublished - Feb 2012

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Keywords

  • biochemical-free progression
  • brachytherapy
  • cryotherapy
  • prostate cancer
  • protons
  • radical prostatectomy
  • radiotherapy

ASJC Scopus subject areas

  • Urology

Cite this

Grimm, P., Billiet, I., Bostwick, D., Dicker, A. P., Frank, S., Immerzeel, J., Keyes, M., Kupelian, P., Lee, W. R., MacHtens, S., Mayadev, J., Moran, B. J., Merrick, G., Millar, J., Roach, M., Stock, R., Shinohara, K., Scholz, M., Weber, E., ... Langley, S. (2012). Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJU International, 109(SUPPL. 1), 22-29. https://doi.org/10.1111/j.1464-410X.2011.10827.x