The value of external beam radiation in node positive prostate cancer: a multivariate analysis

Citation
Ad. Morris et al., The value of external beam radiation in node positive prostate cancer: a multivariate analysis, UROL ONCOL, 6(6), 2001, pp. 255-260
Citations number
12
Categorie Soggetti
Urology & Nephrology
Journal title
UROLOGIC ONCOLOGY
ISSN journal
10781439 → ACNP
Volume
6
Issue
6
Year of publication
2001
Pages
255 - 260
Database
ISI
SICI code
1078-1439(200111/12)6:6<255:TVOEBR>2.0.ZU;2-G
Abstract
Purpose: The goal of this study was to evaluate the effect of local/regiona l treatment, particularly external beam radiation alone vs. radical prostat ectomy plus radiation therapy in patients with pathologic node positive pro state cancer on survival. Methods: Medical records of all 116 patients who received their initial treatment at the Massachusetts General Hospital betw een 1980 and 1996 for adenocarcinoma of the prostate with pathologic confir med nodal metastases and no distant metastases were reviewed. The mean foll ow up was 5.5 years. Overall survival, time to PSA failure on endocrine the rapy, and time to first intervention were evaluated. The effect of the diff erent treatment options were compared using multivariate Cox proportional h azard models to adjust for tumor characteristics that might influence survi val. These included clinical T stage, clinical N stage, Gleason grade, numb er and location of positive lymph nodes and pretreatment PSA. Results: The combined patient population had a 5-year survival rate of 74% and a 10-year survival rate of 48%. Patients receiving local/regional treatment had adju sted 5 year survival rates of 80% compared to 27% for patients receiving no local/regional treatment (p = .001) with corresponding cumulative interven tion rates (CIR) of 11% vs. 73% (p = .01) Patients receiving external beam radiation (XRT) alone did not differ significantly from those receiving pro statectomy plus radiation therapy in terms of survival (75 vs. 82%, p = .23 ) or cumulative intervention rates (14% vs. 14%, p = .94) Conclusion: Altho ugh it appears that all patients with node positive prostate cancer will ev entually develop failure, this paper suggests local/regional therapy offers a medium term survival advantage over no local/regional treatment. The add ition of prostatectomy did not confer a demonstrable advantage over radiati on alone. (C) 2001 Elsevier Science Inc. All rights reserved.