ORCHIECTOMY PRIOR TO DEFINITIVE RADIOTHERAPY FOR LOCALIZED PROSTATIC-CANCER

Purpose: To identify potential survival benefits of cytoreductive orch idectomy performed prior to definitive radiation for localized prostat e cancer. Methods and Materials: Between 1977-1988, all patients with localized prostatic cancer from the Wellington Region received definit ive radiotherapy (n = 200). One referring urologist Peter M. Meffen (P .M.M.) had commenced a program of prior orchidectomy followed by defin itive radiation treatment (median time to radiation therapy was 5 mont hs, n = 30). Results: Five-year overall survival (OS) and relapse-free survival (RFS) for each stage were Stage A 82%, and 82%; Stage B 75%, and 61%; Stage C 57%, and 38%, respectively. Ten-year OS and RFS for each stage were Stage A 78%, and 72%; Stage B 51%, and 18%; Stage C 32 % and 0%, respectively. Multivariate analysis identified prior orchide ctomy treatment and histological grade as independently significant pr ognostic factors for OS and RFS. Factors influencing RFS were clinical stage, prior orchidectomy, and histological grade. Prior orchidectomy was associated with an increase in OS at 5 years when compared to tho se patients receiving radiotherapy alone, 86% vs. 69%, and maintained at 10 years, 82% vs. 46% (p < 0.05). The two groups were comparable by stage, histological grade, and age. There were no changes in the refe rral pattern during the study period. Conclusions: Our results suggest that prior cytoreduction by orchidectomy has a beneficial effect on O S and RFS for patients with localized prostate cancer. It is unclear w hether survival benefits are due to the cytoreductive therapy, the adj uvant therapy, or a combination of both. Further study in this area is warranted, ideally in the form of randomized prospective clinical tri als.