Radical retropubic prostatectomy plus orchiectomy versus orchiectomy alonefor pTxN+ prostate cancer: A matched comparison

Purpose: Untreated stage pTxN+ prostate cancer is associated with a poor ou tcome. Monotherapy (surgery, radiation, hormonal therapy) alone is associat ed with a high progression rate. We evaluate whether radical prostatectomy and pelvic lymphadenectomy plus early adjuvant orchiectomy impart a surviva l advantage compared to pelvic lymphadenectomy and orchiectomy alone in a m atched cohort of patients. Materials and Methods: Between 1966 and 1995, 382 and 79 patients with stag e pTxN+ prostate cancer underwent pelvic lymphadenectomy and radical prosta tectomy plus early adjuvant orchiectomy (within 3 months of prostatectomy), and pelvic lymphadenectomy and orchiectomy only, respectively. We selected 79 matched controls from the prostatectomy plus orchiectomy group for the orchiectomy group. Patients were matched according to the number of positiv e nodes, clinical grade, clinical stage, age, year of surgery and preoperat ive prostate specific antigen (after 1987). The Kaplan-Meier method and str atified Cox proportional hazards model were used to estimate overall and ca use specific survival for the 2 groups. Results: There was an overall survival advantage at 10 years for the prosta tectomy plus orchiectomy (66 +/- 6%) compared to the orchiectomy (28 +/- 6% ) group (p < 0.001, risk ratio 0.36, 95% confidence interval 0.20 to 0.66). There was also an advantage in cause specific survival at 10 years in the prostatectomy plus orchiectomy (79 +/- 5%) versus the orchiectomy (39 +/- 7 %) group (p < 0.001, relative risk 0.28, 95% confidence interval 0.13 to 0. 59). After 1987, when matched on preoperative prostate specific antigen, th e apparent survival advantage at 5 years with radical prostatectomy was sma ller (79 +/- 8 versus 63 +/- 9% orchiectomy) and not significant (p = 0.19) . Conclusions: This retrospective study of patients with stage pTxN+ PC sugge sts that radical prostatectomy with early adjuvant orchiectomy may provide a significant advantage in overall and cause specific survival compared to orchiectomy alone.