INFLUENCE OF DNA-PLOIDY AND ADJUVANT TREATMENT ON PROGRESSION AND SURVIVAL IN PATIENTS WITH PATHOLOGICAL STAGE TT3 (PT3) PROSTATE-CANCER AFTER RADICAL RETROPUBIC PROSTATECTOMY

Objectives To determine whether adjuvant treatment (AT: hormonal or ra diation) affects outcome in pathologic Stage T3 (pT3) prostate cancer when analyzed according to DNA ploidy. Methods. The predictive value o f nuclear DNA ploidy and AT on clinical and prostate-specific antigen (PSA) progression and on overall and cause-specific survival after rad ical retropubic prostatectomy was assessed in 894 patients with pT5 pr ostate cancer. Results. Mean follow-up was 6.7 years (range, 0.3 to 20 ). Mean age was 66 years; (range, 39 to 79). Six hundred sixty patient s (74%) had no immediate AT, 131 (15%) had early adjuvant radiotherapy (ART), and 103 (12%) had early adjuvant orchiectomy (AHT). DNA diploi d tumors were found in 445 patients (52%), tetraploid tumors in 346 (4 1%), and aneuploid tumors in 59 (7%). DNA ploidy was a significant (P < 0.05) prognostic indicator for clinical systemic progression-free su rvival, With PSA progression (more than 0.2 ng/ml) as an endpoint, plo idy was an even more powerful predictor for outcome (P = 0.004). Use o f early AHT or ART was associated with decreased overall clinical prog ression for diploid and nondiploid tumors (P < 0.001 and P < 0.001, re spectively). With respect to PSA progression, ART and AHT were equally effective and superior to no AT only in patients with diploid tumors. However, in patients with nondiploid tumors, only AHT appeared to hav e improved PSA progression-free survival (P < 0.001) over ART or no AT , which are similar in outcome. Conclusions. In the present nonrandomi zed study, AHT was as effective as ART for all endpoints except for PS A more than 0.2 ng/mL progression, for which it appeared to be superio r to ART for patients with nondiploid tumors.