High-grade carcinoma of the prostate: A comparison of current local therapies

Objectives. To determine the impact of either single or combined local therapeutic modalities for poorly differentiated (Gleason score 8 to 10) prostate cancer. Methods. Between 1987 and 1996, 156 patients were diagnosed with biopsy proven, poorly differentiated (Gleason score 8 to 10), clinically localized prostate cancer. Of these patients, 87 were treated with radical prostatectomy alone, 19 with radiotherapy, and 24 with both prostatectomy and postoperative radiotherapy. Results. The median follow-up time was 74.6 months. The 5-year biochemical progression-free survival (PFS) for patients with a Gleason score of 8 to 10 was 65%, 30%, and 20% for patients treated with surgery plus postoperative radiotherapy, radiotherapy alone, and surgery alone, respectively (P <0.0001 between postoperative radiotherapy and all other groups, P = 0.6131 between surgery and radiotherapy). The 5-year clinical PFS was 80%, 60%, and 35% for patients treated with surgery plus postoperative radiotherapy, radiotherapy alone, and surgery alone (P <0.0001 between postoperative radiotherapy and all others, P = 0.1975 between surgery and radiotherapy). The independent prognosticators for biochemical failure included serum prostate-specific antigen level greater than 20 ng/mL and seminal vesicle invasion; only seminal vesicle invasion was prognostic for clinical failure. Conclusions. Patients with high-grade prostate cancer (Gleason score 8 to 10) have uniformly poor, but apparently similar, biochemical and clinical PFS rates when treated by either prostatectomy or radiotherapy alone. The addition of postoperative radiotherapy in the treatment of these patients may be associated with improved biochemical and clinical PFS compared with either modality alone. UROLOGY 57: 1121-1127, 2001. (C) 2001, Elsevier Science Inc.