Elsevier

Urology

Volume 58, Issue 2, August 2001, Pages 233-239
Urology

Adult urology
Addition of radiation therapy to androgen ablation improves outcome for subclinically node-positive prostate cancer

https://doi.org/10.1016/S0090-4295(01)01168-2Get rights and content

Abstract

Objectives. To determine the outcome for node-positive prostate cancer treated by early androgen ablation with or without prostatic radiation.

Methods. Two hundred fifty-five men with lymphadenectomy-proven pelvic nodal metastases treated with early androgen ablation alone (n = 183) or with combined ablation and radiation (n = 72) between 1984 and 1998 were retrospectively reviewed for disease outcome and survival. Post-treatment disease status was based on the prostate-specific antigen levels or on the clinical and radiographic status for patients treated before 1987. Univariate and multivariate statistics were used to determine the prognostic factors and assess the influence of radiation treatment.

Results. With a median follow-up of 9.4 years, the 5, 10, and 13-year overall survival rate for those treated with early ablation alone was 83%, 46%, and 21%, respectively. The freedom from relapse or rising prostate-specific antigen rate for these patients was 41%, 25%, and 19% at 5, 10, and 13 years, respectively. Distant metastasis and local recurrence occurred with a 10-year actuarial incidence of 44% and 51%, respectively. With a median follow-up of 6.2 years, the 5 and 10-year overall survival rate for those treated with radiation and ablation was 92% and 67%, respectively. The freedom from relapse or rising prostate-specific antigen rate in these men was 91% and 80% at 5 and 10 years, respectively. The superior outcome for combined ablation and radiation was substantial and statistically significant in the univariate and multivariate analyses.

Conclusions. Early androgen ablation alone has little curative potential for node-positive prostate cancer. The addition of prostatic radiation to ablation resulted in substantial and significant improvement in disease control and patient survival.

Section snippets

Material and methods

Between 1984 and 1998, inclusive, 255 men with pelvic node-positive prostate cancer were treated either with early androgen ablation alone (n = 183) or with a combination of androgen ablation and external beam radiation therapy (n = 72). The preoperative evaluation included history, physical examination, and radiographic studies with a radionuclide bone scan and pelvic computed tomography scan. No patient had clinical or radiographic evidence of nodal metastatic disease. The primary tumor was

Early androgen ablation alone

The overall survival rate of the 183 men treated with androgen ablation alone was 83%, 46%, and 21% at 5, 10, and 13 years, respectively (Fig. 1). The NED rate declined after the first year to 41%, 25%, and 19% at 5, 10, and 13 years, respectively (Fig. 1). One hundred twenty-six men (69%) had a relapse or rising PSA level. In 71 of the 126, a rising PSA level was found with relapse in one or more local, nodal, or metastatic sites; in 24, a rising PSA level occurred without other evidence of

Comment

Our experience with early androgen ablation for node-positive disease (Fig. 1) is consistent with the limited data available in published reports19, 20 and confirms that such treatment has little curative potential. It is noteworthy that the survival rate did not fall significantly below that expected for 5 years after treatment and only thereafter steadily declined, emphasizing the need for long follow-up to evaluate the differential survival effects of therapy. The major determinants of

Conclusions

Early androgen ablation as the sole treatment for node-positive prostate cancer has limited, if any, curative potential. The addition of local radiation to ablation results in substantial and significant improvements in disease control and patient survival. Aggressive control of the primary tumor aids in eradication of future metastatic clones and contributes to patient survival.

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This study was supported in part by grant CA 06294 awarded by the National Cancer Institute, U.S. Department of Health and Human Services.

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