EXPERIENCE WITH RADICAL PROSTATECTOMY AND RADIATION-THERAPY FOR LOCALIZED PROSTATE-CANCER AT A VETERANS AFFAIRS MEDICAL-CENTER

We assessed the actuarial survival of 357 patients with localized pros tate cancer who were treated with radical prostatectomy or radiation t herapy at a Veterans Affairs Medical Center between 1980 and 1991 and who were followed for a median of 59 months. During this period patien ts with clinical stages A2 and B tumors who had an anticipated life ex pectancy of 10 years or greater were generally treated with surgery. P atients with stages A2 and B tumors who were not candidates for surger y and those with stage C tumors were generally treated with radiation therapy. There were no significant differences among the cause specifi c, clinical disease-free and prostate specific antigen disease-free su rvival curves of patients with stages A2 and B tumors who were treated with radical prostatectomy (138) or radiation therapy (138) but the a ll cause and metastases-free survival curves favored the surgery group (p <0.000001 and 0.046, respectively). There was no significant diffe rence between the all cause survival curves of the patients with stage s A2 and B tumors and of 81 patients with stage C tumors who were trea ted with radiation therapy. However, the cause specific survival curve s favored the patients with stages A2 and B tumors (p = 0.000007). Thi s study demonstrates that there is a high risk of death from co-morbid ities in a hospital based population of American veterans with localiz ed prostate cancer who are not candidates for radical prostatectomy.