RADIOTHERAPY FOR PROSTATIC-CANCER - PATIENT SELECTION AND THE IMPACT OF LOCAL-CONTROL

Objective. To analyze the long-term results of external beam radiation therapy in patients under the age of sixty treated with early-stage p rostate cancer. A comparison is also made between patients with early- stage, node-negative disease and those with locally advanced node-nega tive prostate cancer. Methods. In this retrospective study, 54 patient s who were treated with external beam radiation, when under the age of sixty with Stanford stage T1a and T1b (equivalent to urologic stage B 1), are compared to 75 patients with similar staged disease who were s ixty to seventy years old at time of treatment. In addition, 1 7 men w ho underwent open lymph node dissection with Stanford stage T1a and T1 b NOMO (equivalent to urologic stage B1, pathologic node negative) wer e compared to 30 patients with Stanford stage T3NOMO (equivalent to ur ologic stage C, pathologic node negative) prostatic carcinoma. Results . Patients under the age of sixty with clinically staged early prostat e cancer exhibited a similar rate of local and metastatic control when compared to men treated when sixty to seventy years of age. Overall s urvival was not different than the expected survival in both groups. I n patients with laparotomy-proven node-negative prostate cancer, those with locally advanced tumors had a poorer rate of local control, dise ase-specific survival, freedom from relapse, and survival when compare d to patients with early-stage disease. Conclusions. These results sug gest that men under sixty years old are candidates for radiotherapy, a nd these results are comparable to those attained with prostatectomy. Treatment approaches for controlling bulky local disease in patients w ithout lymph node metastases have a potential to improve local control that may have an impact on survival.