RADICAL PROSTATECTOMY AND POSTOPERATIVE IRRADIATION IN PATIENTS WITH PATHOLOGICAL STAGE-C (T3) CARCINOMA OF THE PROSTATE

Purpose: Adenocarcinoma of the prostate is the most common human cance r of internal organs. Radical surgery is regarded by many to be the tr eatment of choice for capsule confined disease. Since accurate preoper ative assessment of tumor stage is difficult to define, many patients are subsequently found to have pathological stage C (T3) disease. Thes e patients should be considered for adjuvant radiotherapy. Methods and Materials: A group of 201 PS C (T3) unselected patients, treated with radical prostatectomy and limited pelvic lymphadenectomy, received po stoperative irradiation to the prostate bed. This radiotherapy was giv en between 42-90 days after surgery and consisted of a median dose of 48 Gy. Patient survival, disease free survival, time to clinical and c hemical relapse and the incidence of local and systemic relapse were a nalyzed. The influence of multiple parameters on the treatment outcome including patient age, treatment period, clinical stage, pathological stage, Gleason's score, prostate specific antigen (PSA), radiotherapy techniques and radiation dose were examined using univariate and mult ivariate analysis. Follow-up ranged from 3 to 15 years, with a median of 5 years. Results: The overall 5- and 10-year actuarial survival was 92% and 83% (median > 10 years), respectively and the 5- and 10-year disease-free survival (clinical and PSA) was 67% and 53% (median > 10 years), respectively. A total of 61 (30%) patients had a recurrence, i ncluding 23 (11%) patients who had clinical and 38 (19%) who had PSA r ecurrence. Of the 23 patients with clinical recurrence, 10 (5%) had lo cal recurrence, including two patients who had local and systemic recu rrence. Pathological stage and Gleason's score were independently pred ictive of recurrence (each with p < 0.001 after controlling for the ot her). Patients in the worst prognostic category with pathological stag e C3 and Gleason's score 8-10 were predicted to be at 7.2 times the ri sk of recurrence, compared to stage C1 or C2 and Gleason's score 2-7 p atients. Preoperative PSA level (> 25 ng/ml) was also an important ind ependent factor predicting tumor recurrence, p = 0.05. All other inves tigated parameters were not significant in predicting tumor recurrence . This treatment program was very well tolerated by the study patients , with seven (3.5%) recorded with major and 18 (9%) with minor surgica l complications, while 65% of patients had minor and clinically insign ificant radiation complications. Conclusion: Surgery followed by moder ate dose radiotherapy in patients with PS C (T3) prostatic carcinoma w as well tolerated and resulted in excellent overall and disease free s urvival, with a low incidence of local recurrence. New treatment strat egies need to be developed for patients with C3 tumors and those with high (8-10) Gleason's score and those with high (> 25 ng/ml) PSA level at diagnosis. (C) 1998 Elsevier Science Inc.