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Open Access Highly Accessed Research article

Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up

Tomás Merino1*, Ignacio F San Francisco2, Pablo A Rojas2, Piero Bettoli1, Álvaro Zúñiga2 and Pelayo Besa3

Author Affiliations

1 Radiotherapy Unit, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile

2 Urology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

3 Radiotherapy Unit, Clínica las Condes, Santiago, Chile

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BMC Cancer 2013, 13:530  doi:10.1186/1471-2407-13-530

Published: 8 November 2013

Abstract

Background

The objective of this work was to assess the overall survival, cause-specific survival and biochemical failure-free survival of a contemporary cohort of patients with localized prostate cancer (PCa) treated with intensity-modulated radiation therapy (IMRT) or radical prostatectomy (RP).

Methods

We did a retrospective cohort study of our institution’s registry of patients undergoing either IMRT or RP between January 1999 and March 2010, and assessed Prostate Specific Antigen (PSA), age at diagnosis, Gleason score, and digital rectal examination. Two groups were separated according to RP or IMRT treatment and these groups were in turn divided into risk groups according to the D’Amico classification. Overall survival (OS), cause-specific survival (CSS), mortality from other causes (MOC), and biochemical disease-free survival (BDFS) were assessed.

Results

Twelve-hundred patients were included: 993 in the RP group and 207 in the IMRT group.

The IMRT group had older age, PSA at diagnosis and a significantly higher percentage of cancer on the needle biopsy (p <0.001). Of the 207 patients who underwent IMRT, 54% presented comorbidities. Median follow-up was 91.7 months for the RP group and 76 months for the IMRT group. The OS at 5 and 7 was 96.2, and 93.7 for the RP group respectively and 88.4, and 83.1 for the IMRT group respectively (p <0.001). There were no significant differences in the CSS in relation to treatment received among the low- and high-risk groups, while in the intermediate-risk group, patients who underwent to RP had a higher CSS than patients who underwent IMRT (99.6% vs 94.1%, p = 0.003). The IMRT group had a significantly better BDFS than the RP group (86.4% vs. 74.3%, respectively, p = 0.016).

Conclusions

Patients treated with RP were significantly younger and had a better prognosis than patients treated using IMRT, and according to our results, RP had better outcomes in terms of OS while IMRT had greater MOC. Treatment modality did not affect the CSS.

Keywords:
Radical prostatectomy; Prostate cancer; Intensity-modulated radiotherapy