Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy--a propensity scoring approach.

PURPOSE We performed a retrospective cohort study using propensity score analysis to calculate long-term survival in patients with prostate cancer with Gleason score 8 or greater who were treated with conservative therapy, radiation therapy and radical prostatectomy. MATERIALS AND METHODS Between January 1, 1980 and December 31, 1997, 3,159 patients in the Henry Ford Health System were diagnosed with clinically localized prostate cancer. Of these patients 453 had a Gleason score of 8 or greater in the biopsy specimen and they were the cohort. The end points were overall and prostate cancer specific survival. Propensity score analysis was used to more precisely compare the 3 treatments of observation, radiation and radical prostatectomy. Median patient followup was longer in the radical prostatectomy arm than in the conservative treatment and radiation therapy arms (68 months vs 52 and 54, respectively). RESULTS Of the 453 patients 197 (44%) were treated conservatively, 137 (30%) received radiation therapy and 119 (26%) underwent radical prostatectomy. Using propensity scoring analysis median overall survival for conservative therapy, radiation and radical prostatectomy was 5.2, 6.7 and 9.7 years, respectively. Median cancer specific survival was 7.8 years for conservative therapy and more than 14 years for radiation therapy and radical prostatectomy. The risk of cancer specific death following radical prostatectomy was 68% lower than for conservative treatment and 49% lower than for radiation therapy (p<0.001 and 0.053, respectively). CONCLUSIONS Survival of men with high grade prostate cancer can be improved by radical prostatectomy or radiation therapy.