Table 4.

Multi-institutional registry studies.

Author, Institutions	Inclusion criteria	Comparison	Findings
Kibel: Barnes-Jewish Hospital and Cleveland Clinic (1995–2005) (85)	Clinically localized disease; general cohort of 10,429 including 1,234 D'Amico high-risk patients	XRT/ADT or BT vs. RP Note: XRT/ADT—median 74 Gy (Barnes-Jewish) or 78 Gy (Cleveland Clinic) and 82% of high-risk patients received ADT (median 6 months)	Worse OM with XRT/ADT (HR, 1.7; 95% CI, 1.3–2.3) or BT (HR, 3.1; 95% CI, 1.7–5.9) compared with RP, though no detectable difference in PCM in high-risk subset Adjusted 10-year PCM of 1.8% (RP), 2.9% (XRT), or 2.3% (BT)
Westover: 21st Century Oncology, Chicago Prostate Center, Duke University (1988–2008) (81)	Clinically localized, Gleason 8–10, age <75 657 patients included	XRT + BT vs. RP Note: XRT + BT included 45 Gy + minimum 90–108 Gy BT	No detectable difference in PCM, i.e., PCM for RP not detected as worse than CMT (HR, 1.8; 95% CI, 0.6–5.6)
Kishan: 12 tertiary centers (11 in the United States, 1 in Norway) from 2000 to 2013 (83)	Gleason 9–10, clinically localized disease	XRT + BT (MaxRT) vs. RP Note: XRT- median 74.3 Gy, XRT+BT median 91.5 Gy, pelvic nodes included in 40.7% of XRT patients	Improved OM and PCM with MaxRT compared with RP Adjusted 5-year PCM RP 12% (95% CI, 8–17%); EBRT 13% (95% CI, 8–19%); and EBRT + BT, 3% (95% CI, 1–5%) PCM HR MaxRT vs. RP−0.38 (95% CI, 0.21–0.68) OM HR MaxRT vs. RP−0.66 (95% CI, 0.46–0.96)

ADT, androgen deprivation therapy; BT, brachytherapy; CMT, combined modality therapy; Gy, gray; MaxRT, combination external beam radiation therapy and brachytherapy ± ADT; OM, overall mortality; PCM, prostate cancer-specific mortality; RP, radical prostatectomy; RT, radiation therapy; XRT, external beam RT.