Adjuvant radiotherapy in patients with pathologic stage C (pT3N0) adenocarcinoma of the prostate

Objectives. This report is an update on the outcomes in the management of p athologic Stage C (T3N0) prostate cancer (CaP) with postoperative irradiati on. Methods, Between 1976 and 1994, 311 patients with pathologic Stage C CaP we re treated with radical prostatectomy. Pathologic stage was as follows: C1, 60 patients (19%), C2, 146 patients (47%), and C3, 105 patients (34%). Gle ason score was 2 to 4 in 10 patients (3.2%), 5 to 6 in 121 (39%), 7 in 101 (32%), and 8 to 10 in 76 (24%); median prostate-specific antigen (PSA) leve l was 11.9 ng/mL. Postoperative irradiation consisted of a median dose of 4 8 Gy. Follow-up was up to 18 years (median 5). Results. The 10-year actuarial survival was 81% and 10-year disease-free su rvival was 51%, Pathologic stage and Gleason score were independently predi ctive of recurrence, each with P >0.001 after controlling for the other. Pa tients with pathologic Stage C3 and Gleason score 7 to 10 were in the worst prognostic category and had 5.4 times the risk of recurrence compared with patients with pathologic Stage C1-C2, Gleason score 2 to 6. Preoperative P SA was a good (P = 0.02) predictor of disease-free survival. Clinical recur rence was seen in 28 patients (9%), including 10 (3.2%) with local recurren ce, PSA recurrence (PSA greater than 0.05 ng/mL) developed in 68 patients ( 22%). Conclusions, With the known limitations of a nonrandomized clinical trial, on the basis of the experience of this study we recommend the use of modera te dose, limited-field postoperative radiotherapy in patients with patholog ic Stage C disease with Gleason score greater than 4. UROLOGY 53: 1184-1193 , 1999. (C) 1999, Elsevier Science Inc. All rights reserved.