PATHOLOGICAL SEMINAL-VESICLE INVASION AFTER RADICAL PROSTATECTOMY FORPATIENTS WITH PROSTATE CARCINOMA - EFFECT OF EARLY ADJUVANT RADIATION-THERAPY ON BIOCHEMICAL CONTROL

BACKGROUND. The authors evaluated the effect of postoperative radiatio n therapy on freedom from biochemical failure (bNED) in men with prost ate carcinoma who had pathologic seminal vesicle invasion after radica l prostatectomy and negative pelvic lymph node dissection (pT3cN0). ME THODS. Between 1989 and 1995, 375 men underwent radical prostatectomy at Thomas Jefferson University Hospital. Fifty-three men (13%) had pT3 cN0 prostate carcinoma and were the subject of this analysis. Men in w hom prostate specific antigen (PSA) could not be detected were deemed free of biochemical failure. RESULTS. Of the 53 men with pT3cN0 prosta te carcinoma, 18 had an elevated PSA immediately after surgery and rec eived salvage radiation therapy (RT). The 3-year bNED rate for this gr oup was only 38%. At 3 months, PSA could not be detected in the other 35 men. Fifteen of those 35 men underwent early adjuvant RT, and the o ther 20 were observed for biochemical failure. The 3-year bNED rate fo r the 15 patients treated with immediate adjuvant RT was 86%, compared with 48% for the 20 men who were observed (P = 0.01). CONCLUSIONS. Th ese data suggest that early adjuvant RT for men with pT3cN0 prostate c arcinoma and no detectable PSA postoperatively reduces the likelihood of future biochemical failure. Men with pT3cN0 prostate carcinoma and a persistently elevated postoperative PSA level are less likely to ben efit from RT and should be considered for systemic therapy. (C) 1998 A merican Cancer Society.