STAGE D1 PROSTATIC CANCER-EQUIVALENT RESULTS WITH RADIOTHERAPY AND HORMONAL-THERAPY VERSUS RADICAL PROSTATECTOMY, RADIOTHERAPY AND HORMONALTHERAPY()

Background: The value of radiation therapy (RT) and hormonal therapy ( HT) in stage D1 prostatic cancer was to date only sporadically compare d with radical prostatectomy (RP) and hormonal therapy. Patients and M ethods: From 1975 to 1991, 82 patients with pelvic lymph node dissecti on (PLND)-proven stage D1 prostatic carcinoma underwent RT. Twelve pat ients were excluded from analysis because treatment started when local tumor progression was observed. Of the remaining 70 patients 30 initi ally hall an RP with orchiectomy and 40 patients had only a biopsy wit h orchiectomy. All patients had an additional androgen blocking. Fifty -five out of 70 patients were treated with photons up to a total dose of 4,000-5,000 cGy to the pelvic lymphatics and an additional boost to the prostatic region to deliver 6,000-7,000 cGy. In 12 out of 67 pati ents 14-MeV fast neutrons were used for the boost. Three patients had only a local RT. Results: The median follow-up in 30 patients with RP, designated as group I, was 54 months and in 40 patients with biopsy o nly, designated as group II, was 58 months. The 5- and 10-year overall survival (OS) rates were 90 and 53% in group I compared to 72 and 41% in group II, respectively (p > 0.05). The cause-specific survival (CS S) for 5 and 10 years was 100 and 58% versus 79 and 72% (p > 0.05). Di sease-free survival (DFS) for 5 and 10 years was 70% in group I and 65 and 24% in group II, respectively (p>0.05). Local control (LC) for 5 and 10 years was 87% (group I) versus 94% (group II) and 87% (group I) versus 65% (group II) (p>0.05). Major complications occurred in 6% (4 patients); all of these were treated following RP. Conclusions: In th e present series no significant advantage was seen for patients treate d with RP, RT and HT, compared to RT and HT. RT in combination with im mediate HT seems to be able to achieve results comparable with those o f RP when using immediate HT. This should be proven in prospective cli nical trials.