Influence of the extent of nodal involvement on the outcome in stage D1 prostate cancer

摘要

AbstractFrom 1975 to 1991, 82 patients with pathological stage D1 prostate cancer underwent radiation therapy. Twelve patients were excluded from analysis because treatment started when local tumor progression was determined. Of the 70 remaining patients, 30 initially had a radical prostatectomy with orchiectomy and 40 patients had only a biopsy with orchiectomy. All patients had an additional androgen blocking. Sixty‐seven of 70 patients were treated with photons up to a total dose of 4,000–5,000 cGy to the small pelvis and 55 of 67 received an additional boost to the prostatic region to deliver 6,000–7,000 cGy. In 12 cases, 14 MeV fast neutrons were used for the boost. Three patients underwent only irradiation of the prostate. With a median follow up of 58 months (range: 3–183 months), the overall survival rate (OS) for 5 and 10 years was 78 and 45, respectively. The cause‐specific survival rate was 86 and 69 for 5 and 10 years, respectively. Thirteen patients with one microscopically positive node (group I) had an OS of 90 and 68 (5 and 10 years, respectively) compared to 57 patients with one or more microscopically positive nodes (group II), who had an OS of 75 and 40, respectively (P>0.05). A significant advantage for patients with microscopically involved nodes was seen in disease‐free survival: 84 vs. 62 for 5 years and 63 vs. 27 for 10 years (P<0.05) and in cause specific survival: 100 vs. 82 for 5 years and 100 vs. 59 for 10 years (P<0.05). Major complications occurred in four patients (6); all of these were treated following prostatectomy. Prospective randomized clinical trials should compare the results of radiotherapy and hormonal treatment with radical prostatectomy and hormonal treatment and hormonal treatment alone in stage D1 prostate cancer. The treatment of choice remains unclear. © Wil