15-YEAR SURVIVAL AND RECURRENCE RATES AFTER RADIOTHERAPY FOR LOCALIZED PROSTATE-CANCER

Purpose: To determine 15-year survival and recurrence rates after radi otherapy for localized prostate cancer. Methods: One hundred thirty-si x patients with clinically localized prostate cancer treated from 1966 to 1974 with interstitial gold seed and external-beam irradiation wer e evaluated to determine the probability of recurrence and survival gr eater than or equal to 15 years after therapy. All patients were surgi cally staged with pelvic lymphadenectomy and none received hormonal th erapy before relapse. Results: Overall, 60 patients (44%) have never r ecurred, although 57% (34 of 60) of these same patients have died of c auses other than prostate cancer. Local progression developed in 39% o f patients and distant metastases in 42%. At 15 years, the probability of dying of prostate cancer was 33% +/- 8% (% +/- 2 SE) and of all ca uses wets 72% +/- 8%. In clinical stage A2 and B, 29% +/- 9% of patien ts died of their cancer within 15 years, compared with 57% +/- 21% in stage C1, while only 18% +/- 8% with clinical stage A2 and B and negat ive lymph nodes died of cancer within this period. In contrast, the pr ostate cancer mortality rate at 15 years was high for patients with po sitive nodes regardless of the stage of the primary tumor (73% for A2 and B; 71% for C1). Patients with nodal metastases, poorly differentia ted tumors, and advanced local disease all had a significantly (P < .0 001) increased risk of cancer death. Conclusion: The cancer-specific m ortality rate for patients with stage A2 and B tumors and negative nod es compares favorably with other series of patients treated with radia tion therapy and greater than or equal to 15 years' follow-up evaluati on. While local progression rates ore high and associated with a subst antial risk of prostate cancer death, many patients live with the dise ase and ultimately die of causes other than prostate cancer. (C) 1997 by American Society of Clinical Oncology.