Adult urologyAddition of radiation therapy to androgen ablation improves outcome for subclinically node-positive prostate cancer☆
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.
References (20)
- et al.
Prognosis of patients with stage D1 prostate carcinoma following radical prostatectomy with and without early endocrine therapy
J Urol
(1990) - et al.
Ten-year outcomes for pathologic node-positive patients treated in RTOG 75-06
Int J Radiat Oncol Biol Phys
(1998) - et al.
Combined orchiectomy and external radiotherapy versus radiotherapy alone for nonmetastatic prostate cancer with or without pelvic lymph node involvementa prospective randomized study
J Urol
(1998) - et al.
Early androgen ablation for stage D1 (N1 to N3, M0) prostate cancerprognostic variables and outcome
J Urol
(1994) - et al.
Radical prostatectomy plus orchiectomy versus orchiectomy alone for pTxN+ prostate cancera matched comparison
J Urol
(1999) - et al.
Influence of radiotherapy on node-positive prostate cancer treated with androgen ablation
Int J Radiat Oncol Biol Phys
(1995) - et al.
The use of combined radiation therapy and hormonal therapy in the management of lymph node-positive prostate cancer
Int J Radiat Oncol Biol Phys
(1997) - et al.
Androgen suppression plus radiation versus radiation alone for patients with D1 (pN+) adenocarcinoma of the prostate (results based on a national prospective randomized trial, RTOG 85-31)
Int J Radiat Oncol Biol Phys
(1997) - et al.
Pelvic lymphadenectomy for staging clinically localized prostate cancerindications, complications and results in 217 cases
Urology
(1990) - et al.
Stage D1 (T1–3, N1–3, M0) prostate cancera case-controlled comparison of conservative treatment versus radical prostatectomy
Urology
(1997)
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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.