Date of Award

10-19-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Richard Peschel

Second Advisor

Dr. Lynn Wilson

Third Advisor

Dr. Joanne Weidhaas, Dr. John Concato

Abstract

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. Methods and Materials: Between 1997-2005, a consecutive sample of 556 patients who underwent RP (n=204) or IMRT (n=352) at two referral centers was analyzed. Patients were stratified into prognostic groups based on clinical stage, Gleason score, and pretreatment prostate specific antigen (PSA) level as outlined by schemes designed by Memorial Sloan Kettering (MSK) and the National Comprehensive Cancer Network (NCCN). The outcome used in this study was BDFS. Median follow up in the RP and IMRT cohorts was 46 months and 40 months, respectively. Results: IMRT patients had more advanced and aggressive disease at baseline (p<.001). No difference was found in five-year BDFS rates between RP and IMRT in the favorable prognosis (92.8% vs. 85.3%, p=.20) or the MSK intermediate prognosis (86.7% vs. 82.2%, p=.46) subsets. A difference favoring IMRT was seen in the NCCN intermediate prognosis (70.7% vs. 83.3%, p=.03), MSK poor prognosis (38.4% vs. 62.2%, p<.001), and NCCN poor prognosis (37.0% vs. 56.8%, p=.005) subsets. 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 MSK poor prognosis subset, treatment modality (p=.006) was predictive of BDFS, favoring IMRT. Conclusion: Biochemical disease free survival is similar between RP and IMRT for patients with a good prognosis. Patients with a poor prognosis, and some with an intermediate prognosis, may benefit from IMRT to ≥72 Gy plus hormonal therapy.

Comments

This is an Open Access Thesis.

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