Long-term results of a randomized trial for the treatment of Stages B2 andC prostate cancer: Radical prostatectomy versus external beam radiation therapy with a common endocrine therapy in both modalities

Objectives. To improve the treatment of locally advanced prostate cancer (S tages B2 and C), a prospective randomized trial was conducted to compare ra dical prostatectomy versus external beam radiotherapy with the combination of endocrine therapy in both modalities. Methods. One hundred patients were enrolled and 95 were evaluated. Forty-si x patients underwent radical prostatectomy with pelvic lymph node dissectio n, and 49 were treated with radiation by linear accelerator with 40 to 50 G y to the whole pelvis and a 20-Gy boost to the prostatic area. For all pati ents, endocrine therapy was initiated 8 weeks before surgery or radiation, and continued thereafter. The living patients were asked to respond to a qu ality-of-life questionnaire. Results. The follow-up period ranged from 6.0 to 94.4 months (median 58,5). The progression-free and cause-specific survival rates at 5 years were 90. 5% and 96.6% in the surgery group and 81.2% and 84.6% in the radiation grou p, respectively. The surgery group had better progression-free and cause-sp ecific survival rates (P = 0.044 and 0.024, respectively). More patients in the surgery group complained of urinary incontinence. The questionnaire re vealed that quality of life was less disturbed in the radiation group. Conclusions, Radical prostatectomy combined with endocrine therapy may cont ribute to the survival benefit of patients with locally advanced prostate c ancer. External beam radiotherapy in combination with endocrine therapy can be used in selected patients because of its low morbidity. (C) 1999, Elsev ier Science Inc.