Adjuvant Radiotherapy Following Radical Prostatectomy: Results and Complications
Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma clinically confined to the prostate gland. This report is based on 45 of these patients with microscopic extension of disease beyond the gland and a minimum 5-year follow-up. Of the patients 22 received adjuvant external beam radiation therapy and 23 did not. The groups were comparable with regard to significant prognostic variables. Patient selection was by surgeon preference. Local recurrences were seen in 1 of 22 patients (5 percent) receiving adjuvant radiotherapy and 7 of 23 (30 percent) undergoing an operation alone (p <0.05). Of 8 patients with local recurrence 7 died of the disease. Delayed radiotherapy of a local recurrence generally was not effective in controlling the disease. Of the 11 patients who died of prostatic cancer with a mean follow-up of 9.2 years 3 received adjuvant radiotherapy and 8 did not. Severe but nonfatal long-term complications were seen in 14 percent of the irradiated patients and 6 percent of those treated with an operation alone. Most of the complications occurred in the earlier years of the study in patients who received 60cobalt radiotherapy. When clinical Stage B cancer of the prostate is found to be pathological Stage C following radical perineal prostatectomy, adjuvant radiotherapy can decrease the incidence of subsequent local recurrence. The potential risk of adjuvant radiation therapy should be weighed and its use considered, particularly in patients whose tumor extends to the surgical margins or who have seminal vesicle invasion.
The use of adjuvant irradiation following radical prostatectomy when disease is found microscopically to extend beyond the prostate gland or when surgical excision has been incomplete has been reported previously (1–6). We reviewed the outcome and complications of treatment in 45 of our patients with microscopic disease outside the prostatic capsule following radical perineal prostatectomy performed for clinically localized disease. Of these patients 22 received adjuvant external beam irradiation and 23 did not. Mean follow-up exceeds the mean time to local or distant recurrence. We believe the findings better define the role of adjuvant radiotherapy following total prostatectomy.
KeywordsLocal Recurrence Radical Prostatectomy Seminal Vesicle Pathological Stage Distant Recurrence
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