SURGERY WITH ADJUVANT IRRADIATION IN PATIENTS WITH PATHOLOGICAL STAGE-C ADENOCARCINOMA OF THE PROSTATE

Background. In recent years, the routine use of prostate-specific anti gen (PSA) to detect cancer of the prostate (CaP) early has renewed the controversy regarding radiotherapy versus radical prostatectomy as th e superior definitive treatment. Radiotherapy alone has been reported to result in a high incidence of local recurrence, whereas on the othe r hand surgical treatment has resulted in a high incidence of microsco pic residual tumor. The purpose of this study was to review our treatm ent results with radical prostatectomy followed by planned courses of postoperative irradiation in patients with pathologic Stage (PS)C dise ase. Methods. From 1972 to 1989, 95 patients with CaP with PS C tumors were treated with radical prostatectomy and bilateral pelvic lymphade nectomy. Pathologic stage distribution was: C1 in 26 (27%), C2 in 37 ( 39%), and C3 in 32 (34%) patients. The median follow-up was 6 years. A ll 95 study patients received postoperative pelvic irradiation as the only adjuvant treatment. Radiotherapy treated volume included the pros tatic fossa and its immediate vicinity. The RT dose ranged from 33 Gy to 61.8 Gy (median, 45 Gy). Results. The overall 5- and 10-year actuar ial survival rates were 94% and 73%, respectively, with the 5 and 10 y ear disease specific survival of 98% and 91%, respectively. Clinical a nd/or prostate specific antigen recurrence was 31% at 5 years and 44% at 10 years. Prostate specific antigen elevation without clinical evid ence of recurrent disease was recorded in 26 (27%) patients. Seminal v esicle involvement (C3) and high Gleason's score (8-10) were the mast important factors predicting recurrence. Of the 95 patients treated, 2 had pelvic recurrence alone and I had local and distant metastatic di sease. Radiotherapy was well tolerated with no clinically important mo rbidity. Conclusion. Based on this experience, moderate dose adjuvant radiotherapy after radical prostatectomy in patients with PS C Cap is recommended.