Radical prostatectomy and postoperative irradiation in patients with
pathological stage C (T3) carcinoma of the prostate.

Int J Radiat Oncol Biol Phys 1998;40(1):139-47

Petrovich Z; Lieskovsky G; Langholz B; Formenti S; Baert L; Streeter O;
Skinner DG
Department of Radiation Oncology, University of Southern California
School of Medicine in Los Angeles, 90033, USA.
PURPOSE: Adenocarcinoma of the prostate is the most common human
cancer of internal organs. Radical surgery is regarded by many to be
the treatment of choice for capsule confined disease. Since accurate
preoperative assessment of tumor stage is difficult to define, many
patients are subsequently found to have pathological stage C (T3)
disease. These patients should be considered for adjuvant radiothera-
py. METHODS AND MATERIALS: A group of 201 PS C (T3) unselected
patients, treated with radical prostatectomy and limited pelvic
lymphadenectomy, received postoperative irradiation to the prostate
bed. This radiotherapy was given between 42-90 days after surgery and
consisted of a median dose of 48 Gy. Patient survival, disease free
survival, time to clinical and chemical relapse and the incidence of
local and systemic relapse were analyzed. The influence of multiple
parameters on the treatment outcome including patient age, treatment
period, clinical stage, pathological stage, Gleason's score, prostate
specific antigen (PSA), radiotherapy techniques and radiation dose
were examined using univariate and multivariate analysis. Follow-up
ranged from 3 to 15 years, with a median of 5 years. RESULTS: The
overall 5- and 10-year actuarial survival was 92% and 83% (median >
10 years), respectively and the 5- and 10-year disease-free survival
(clinical and PSA) was 67% and 53% (median > 10 years), respectively.
A total of 61 (30%) patients had a recurrence, including 23 (11%)
patients who had clinical and 38 (19%) who had PSA recurrence. Of the
23 patients with clinical recurrence, 10 (5%) had local recurrence,
including two patients who had local and systemic recurrence.
Pathological stage and Gleason's score were independently predictive
of recurrence (each with p < 0.001 after controlling for the other).
Patients in the worst prognostic category with pathological stage C3
and Gleason's score 8-10 were predicted to be at 7.2 times the risk
of recurrence, compared to stage C1 or C2 and Gleason's score 2-7
patients. Preoperative PSA level (> 25 ng/ml) was also an important
independent factor predicting tumor recurrence, p = 0.05. All other
investigated parameters were not significant in predicting tumor
recurrence. This treatment program was very well tolerated by the
study patients, with seven (3.5%) recorded with major and 18 (9%)
with minor surgical complications, while 65% of patients had minor
and clinically insignificant radiation complications. CONCLUSION:
Surgery followed by moderate dose radiotherapy in patients with PS C
(T3) prostatic carcinoma was well tolerated and resulted in excellent
overall and disease free survival, with a low incidence of local
recurrence. New treatment strategies need to be developed for
patients with C3 tumors and those with high (8-10) Gleason's score
and those with high (> 25 ng/ml) PSA level at diagnosis.