Radical Prostatectomy Results In Survival Comparable To Radiotherapy With Androgen Deprivation Of Patients With Stage T4 Prostate Cancer

Dr. Johnstone and co-authors report in the epub version of Cancer that radical prostatectomy (RP) in men with T4 prostate cancer (CaP) provides survival superior to men treated with radiotherapy (RT) or androgen deprivation (AD) alone and similar to RT and AD combined.

The analysis used the Surveillance, Epidemiology and End Results (SEER) database for a 7-year period 1995-2001 to include 1,093 patients with stage cT4 CaP, and either lymph node negative or positive disease. All men were clinically without evidence of distant metastasis.

The survival of these men was examined and compared based upon 5 treatment groups; RP, RT alone, AD alone, RT with AD, and no treatment. Most men were Caucasian and age greater than 65 years. Unfortunately, 58% of the entire study population did not have staging of the lymph nodes. Most of these did not include surgery patients. Only 72 men (6.6%) underwent RP and only 50 of these had RP alone.

The observed 5-year survivals for RP, RT, AD, RT with AD and no treatment were 73%, 62%, 42%, 71%, and 40%, respectively. Adding adjuvant RT or AD to RP patients conferred no survival benefit. A significant increase in death was observed among patients in the AD-only and no treatment groups compared with the RP group. The survival differences were most apparent in the small number of patients who had positive regional lymph nodes. Otherwise RT with AD resulted in a small, but not significant survival improvement.

The limitations of this study clearly include the small number of patients who had accurate pelvic lymph node staging.

By Christopher P. Evans, M.D.

References:
Cancer 2006;epub
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