RESULTS OF EXTERNAL-BEAM RADIOTHERAPY IN 448 PATIENTS WITH CLINICALLYLOCALIZED ADENOCARCINOMA OF THE PROSTATE

The results of external beam radiotherapy for clinically localized ade nocarcinoma of the prostate in 448 patients treated in the period 1980 -90 were reviewed. The average follow up was 4.9 years. The patients w ere aged 44-87 years (median 69 years) and all had histopathological e vidence of adenocarcinoma by needle biopsy or transurethral resection of prostate. The histopathological grading was: 127 G1; 154 G2; 127 G3 ; 12 G4; 28 G(X). Clinical staging according to TNM (American Urologic al Association) was: 29 T0 (A2); 4 T1 (B1); 173 T2 (B2); 176 T3 (C1); 63 T4 (C2); 3 T(X). Routine surgical pelvic lymph node staging was not performed but patients had radiological (computerized tomography scan or lymphogram) nodal staging: 350 N0; 22 N1; 12 N2; 64 N(X). High ene rgy linear accelerator external beam radiotherapy was given by multipl e fields to total doses of 50-70 Gy (median 60 Gy). The majority of pa tients (307, 69%) was treated by a uniform policy under the care of on e radiation oncologist (HM). The rates of local and distant failure at 5 years were 10% (s.e. = 2%) and 42% (s.e. = 3%), respectively. The l ate complication rate at 5 years was 25% (s.e. = 2%), comprising mild 16%, moderate 7% and severe 1.3%. The 5 year overall survival rate was 64% (s.e. = 2%) and the cancer-specific survival rate was 74% (s.e. = 3%). Both histological grade and clinical stage were strongly predict ive of overall survival and distant failure. Only histological grade w as predictive of local failure. Treatment with external beam radiother apy for this common cancer resulted in survival and disease control ra tes that compare favourably with other published radiotherapy series a nd has been accompanied by acceptably low morbidity.