UroToday - We feel that this work is an important contribution to the literature as it compares outcomes across three different modalities.

One aspect with which the authors struggled was how to address the poor outcomes for surgical patients. Three randomized trials have shown a biochemical benefit for adjuvant external beam radiation after surgery.

Surgical patients treated with adjuvant radiation were excluded because we could not attribute biochemical control in these patients to either surgery or radiation. The poor outcomes for surgical patients were ultimately felt to be impacted by the inclusion of patients treated with laparoscopic surgery. Data at our institution as well as a recently published article in the Journal of Clinical Oncology have shown inferior outcomes for laparoscopic prostatectomy.

In the end, we felt the ultimate goal of the study was to show that biopsy Gleason 7 primary grade 3 prostate cancer has an improved biochemical relapse free survival compared to primary grade 4. The data supported primary grade being an independent prognostic factor and that was the emphasis of the study rather than the individual subset analyses.

Michael Burdick, MD, as part of Beyond the Abstract on UroToday

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